Provider Demographics
NPI:1346830759
Name:WILLIAMS, KAYLA MARIE I (HIS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:I
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2359
Mailing Address - Country:US
Mailing Address - Phone:731-668-6076
Mailing Address - Fax:731-668-7033
Practice Address - Street 1:65 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2359
Practice Address - Country:US
Practice Address - Phone:731-668-6076
Practice Address - Fax:731-668-7033
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN928237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN928OtherCOMMERCIAL INSURANCE