Provider Demographics
NPI:1851090153
Name:WILLIAMS, KIARA M (DOO)
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 E BERWALD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3925
Mailing Address - Country:US
Mailing Address - Phone:216-304-9673
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3549
Practice Address - Country:US
Practice Address - Phone:216-304-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1832064374U00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH810970347Medicaid
OH0472408Medicaid