Provider Demographics
NPI:1508323528
Name:WILLIAMS, KELLY MIKEL
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MIKEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2682
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-2682
Mailing Address - Country:US
Mailing Address - Phone:202-427-2222
Mailing Address - Fax:
Practice Address - Street 1:1003 ANDERSON PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4405
Practice Address - Country:US
Practice Address - Phone:202-427-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant