Provider Demographics
NPI:1508286360
Name:WILLIAMS, ANITA KAYE (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:KAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WAYLAWN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-2305
Mailing Address - Country:US
Mailing Address - Phone:601-566-9467
Mailing Address - Fax:
Practice Address - Street 1:103 WAYLAWN CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-2305
Practice Address - Country:US
Practice Address - Phone:601-566-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883265163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health