Provider Demographics
NPI:1417725136
Name:WILLIAMS, KAYLEEANNA
Entity Type:Individual
Prefix:
First Name:KAYLEEANNA
Middle Name:
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 1:3402 E CAROL ANN WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3820
Mailing Address - Country:US
Mailing Address - Phone:509-431-2394
Mailing Address - Fax:
Practice Address - Street 1:2900 W BROADWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4518
Practice Address - Country:US
Practice Address - Phone:602-377-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist