Provider Demographics
NPI:1952504847
Name:WILLIAMS, WAUKITA
Entity Type:Individual
Prefix:
First Name:WAUKITA
Middle Name:
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 1:1211 MCGEE ST
Mailing Address - Street 2:ROOM 905-B
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2416
Mailing Address - Country:US
Mailing Address - Phone:816-418-7840
Mailing Address - Fax:816-418-1807
Practice Address - Street 1:1211 MCGEE ST
Practice Address - Street 2:ROOM 905-B
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2416
Practice Address - Country:US
Practice Address - Phone:816-418-7840
Practice Address - Fax:816-418-1807
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00364174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist