Provider Demographics
NPI:1801153291
Name:WILLIAMS, KATEMA NICOLE
Entity type:Individual
Prefix:
First Name:KATEMA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 W SAN FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2917
Mailing Address - Country:US
Mailing Address - Phone:314-723-2626
Mailing Address - Fax:
Practice Address - Street 1:4204 W SAN FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2917
Practice Address - Country:US
Practice Address - Phone:314-723-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOGH8 GOG347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle