Provider Demographics
NPI:1689084832
Name:WILLIAMS, KAYONTAE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYONTAE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 EDWARDS STREET STE 830
Mailing Address - Street 2:539
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:225-351-1506
Mailing Address - Fax:225-267-4311
Practice Address - Street 1:3610 S LOYOLA DR
Practice Address - Street 2:APT 383
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-6415
Practice Address - Country:US
Practice Address - Phone:985-224-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231737363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health