Provider Demographics
NPI:1336800168
Name:WILLIAMS, KASSIDY NOELLE (CNA, MA-P)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:NOELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA, MA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9704 NE 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2779
Mailing Address - Country:US
Mailing Address - Phone:360-608-7578
Mailing Address - Fax:
Practice Address - Street 1:11719 NE 95TH ST STE D
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-2444
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:360-397-8449
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61239792246RP1900X
WANC60791384376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy