Provider Demographics
NPI:1093784449
Name:WILLIAMS, KENNETH ALAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 103 BOX 3527
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:ITALY
Mailing Address - Zip Code:AE
Mailing Address - Country:US
Mailing Address - Phone:043-478-1795
Mailing Address - Fax:
Practice Address - Street 1:PSC 103 BOX 3527
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:ITALY
Practice Address - Zip Code:AE
Practice Address - Country:US
Practice Address - Phone:043-478-1795
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered