Provider Demographics
NPI:1598318420
Name:WILLIAMS, KENDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 BLACKBOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SEALE
Mailing Address - State:AL
Mailing Address - Zip Code:36875-4708
Mailing Address - Country:US
Mailing Address - Phone:706-615-1034
Mailing Address - Fax:
Practice Address - Street 1:1425 WYNNTON RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-5718
Practice Address - Country:US
Practice Address - Phone:706-780-6332
Practice Address - Fax:706-786-6442
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211461363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily