Provider Demographics
NPI:1740537265
Name:WILLIAMS, KATIE L (LPN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 HIGHWAY 49 N
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4087
Mailing Address - Country:US
Mailing Address - Phone:870-560-5260
Mailing Address - Fax:
Practice Address - Street 1:528 HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4087
Practice Address - Country:US
Practice Address - Phone:870-560-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL45336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse