Provider Demographics
NPI:1932748746
Name:WILLIAMS-PERRY, KHALILAH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KHALILAH
Middle Name:
Last Name:WILLIAMS-PERRY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-7139
Practice Address - Street 1:2817 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2132
Practice Address - Country:US
Practice Address - Phone:845-457-3155
Practice Address - Fax:845-457-9036
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05972041Medicaid