Provider Demographics
NPI:1336787100
Name:WILLIAMS, KAWANA JEFFER (APRN, PHD)
Entity Type:Individual
Prefix:MRS
First Name:KAWANA
Middle Name:JEFFER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 1ST ST NE APT 528
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4798
Mailing Address - Country:US
Mailing Address - Phone:240-620-1587
Mailing Address - Fax:
Practice Address - Street 1:3030 30TH ST SE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1657
Practice Address - Country:US
Practice Address - Phone:240-620-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0001264103103TB0200X, 103TS0200X, 163WA2000X, 163WD0400X
DCRN1039613103TA0700X, 103TB0200X, 103TH0100X, 103TS0200X, 163WD0400X
DC0001264103103TH0004X, 1744R1102X, 163WG0100X
MDRN1039613163WC0400X
VA0001264103163WC1500X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No1744R1102XOther Service ProvidersSpecialistResearch Study
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1336787100Medicaid
DC1992339006Medicaid
MD831540608Medicaid