Provider Demographics
NPI:1013457969
Name:WILLIAMS, KORI RAEANN (FNP)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:RAEANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 WOODBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7035
Mailing Address - Country:US
Mailing Address - Phone:661-428-7456
Mailing Address - Fax:
Practice Address - Street 1:8307 BRIMHALL RD
Practice Address - Street 2:STE 1707
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2251
Practice Address - Country:US
Practice Address - Phone:661-587-8990
Practice Address - Fax:661-587-8980
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004591363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care