Provider Demographics
NPI:1790126910
Name:WILLIAMS, KEVIN JAMES (RN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PEONEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-9510
Mailing Address - Country:US
Mailing Address - Phone:509-486-1260
Mailing Address - Fax:866-626-4289
Practice Address - Street 1:109 PEONEY CREEK RD
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9510
Practice Address - Country:US
Practice Address - Phone:509-486-1260
Practice Address - Fax:866-626-4289
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00175612163W00000X, 163WC0400X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development