Provider Demographics
NPI:1407271075
Name:WILLIAMS, KYMOUYE JOURDEANE
Entity Type:Individual
Prefix:
First Name:KYMOUYE
Middle Name:JOURDEANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ARBOR HILL DR APT 19
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5639
Mailing Address - Country:US
Mailing Address - Phone:845-232-3244
Mailing Address - Fax:
Practice Address - Street 1:14 ARBOR HILL DR APT 19
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-5639
Practice Address - Country:US
Practice Address - Phone:845-232-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317479164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse