Provider Demographics
NPI:1821587197
Name:WILLIAMS, TAMPA YVETTE
Entity Type:Individual
Prefix:MS
First Name:TAMPA
Middle Name:YVETTE
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 1:6811 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-9423
Mailing Address - Country:US
Mailing Address - Phone:318-990-8276
Mailing Address - Fax:
Practice Address - Street 1:116 SOUTH DR STE L
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5067
Practice Address - Country:US
Practice Address - Phone:318-354-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA861846161OtherINTERNAL REVENUE SERVICE