Provider Demographics
NPI:1225616964
Name:WILLIAMS, NATASHA ROCHELLE
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ROCHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:ROCHELLE
Other - Last Name:WILIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:KILLONA
Mailing Address - State:LA
Mailing Address - Zip Code:70057-3044
Mailing Address - Country:US
Mailing Address - Phone:504-782-5527
Mailing Address - Fax:
Practice Address - Street 1:17905 RIVER RD APT H
Practice Address - Street 2:
Practice Address - City:KILLONA
Practice Address - State:LA
Practice Address - Zip Code:70057-3162
Practice Address - Country:US
Practice Address - Phone:504-782-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009050175171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA009050175Medicaid