Provider Demographics
NPI:1568814564
Name:WILLIAMS, KETHRONE
Entity Type:Individual
Prefix:
First Name:KETHRONE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 BIENVENUE AVE
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4704
Mailing Address - Country:US
Mailing Address - Phone:504-343-2523
Mailing Address - Fax:
Practice Address - Street 1:201 SAINT CHARLES AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70170-1000
Practice Address - Country:US
Practice Address - Phone:954-603-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist