Provider Demographics
NPI:1497060537
Name:WILLIAMS, KRYSTAL SHARMEL (HHA RMA)
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:SHARMEL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HHA RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18803 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240
Mailing Address - Country:US
Mailing Address - Phone:313-687-2479
Mailing Address - Fax:
Practice Address - Street 1:18803 GARFIELD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240
Practice Address - Country:US
Practice Address - Phone:313-687-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI272891446374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI272891446Medicaid