Provider Demographics
NPI:1629895347
Name:WILLIAMS, PRESLEY KALYN (BSW)
Entity type:Individual
Prefix:
First Name:PRESLEY
Middle Name:KALYN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSW
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 2687
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-2687
Mailing Address - Country:US
Mailing Address - Phone:580-272-5560
Mailing Address - Fax:580-272-5554
Practice Address - Street 1:2016 TE ATA DRIVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-272-5580
Practice Address - Fax:580-272-5554
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator