Provider Demographics
NPI:1780127753
Name:WILLIAMS, DAKOTA (KPSS)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:KPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-7800
Mailing Address - Country:US
Mailing Address - Phone:606-359-1337
Mailing Address - Fax:
Practice Address - Street 1:125 N CROSS MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist