Provider Demographics
NPI:1821158650
Name:WILLIAMS, KATHY ANN PIPPINS
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN PIPPINS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 PEGUES PL
Mailing Address - Street 2:A
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4027
Mailing Address - Country:US
Mailing Address - Phone:903-753-1000
Mailing Address - Fax:903-753-1225
Practice Address - Street 1:911 PEGUES PL
Practice Address - Street 2:A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4027
Practice Address - Country:US
Practice Address - Phone:903-753-1000
Practice Address - Fax:903-753-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005398163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024337001Medicaid
TX752692040OtherEIN
TX459294Medicare Oscar/Certification