Provider Demographics
NPI:1265193460
Name:WILLIAMS, SHAWNTEANIKA MARCIA
Entity type:Individual
Prefix:
First Name:SHAWNTEANIKA
Middle Name:MARCIA
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 1:10002 RENO RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-3927
Mailing Address - Country:US
Mailing Address - Phone:903-352-8916
Mailing Address - Fax:469-930-5905
Practice Address - Street 1:10002 RENO RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-3927
Practice Address - Country:US
Practice Address - Phone:903-352-8916
Practice Address - Fax:469-930-5905
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA7Z9K8D7374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS5125OtherATTENDANT CARE