Provider Demographics
NPI:1306516828
Name:WILLIAMS, K'IARA CHARMAINE (ATC)
Entity type:Individual
Prefix:
First Name:K'IARA
Middle Name:CHARMAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 MCCART AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3680
Mailing Address - Country:US
Mailing Address - Phone:682-266-6515
Mailing Address - Fax:
Practice Address - Street 1:4108 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2604
Practice Address - Country:US
Practice Address - Phone:817-238-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer