Provider Demographics
NPI:1558379529
Name:WILLIAMS, KEKA LANAY
Entity Type:Individual
Prefix:MRS
First Name:KEKA
Middle Name:LANAY
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 1:1868 RODRIQUE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-1268
Mailing Address - Country:US
Mailing Address - Phone:850-575-4120
Mailing Address - Fax:850-576-3848
Practice Address - Street 1:1868 RODRIQUE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-1268
Practice Address - Country:US
Practice Address - Phone:850-575-4120
Practice Address - Fax:850-576-3848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor