Provider Demographics
NPI:1568070951
Name:WILLIAMS, KARTRINA LYN
Entity Type:Individual
Prefix:MS
First Name:KARTRINA
Middle Name:LYN
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:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-1726
Mailing Address - Country:US
Mailing Address - Phone:985-276-0759
Mailing Address - Fax:
Practice Address - Street 1:848 ASHEVILLE DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2106
Practice Address - Country:US
Practice Address - Phone:985-276-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006356219172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver