Provider Demographics
NPI:1568249068
Name:WILLIAMS, LESA GAYLE (MHA, BSN, RN, CRRN)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:GAYLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MHA, BSN, RN, CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2704
Mailing Address - Country:US
Mailing Address - Phone:575-993-1645
Mailing Address - Fax:
Practice Address - Street 1:609 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-2704
Practice Address - Country:US
Practice Address - Phone:575-993-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse