Provider Demographics
NPI:1306486907
Name:WILLIAMS, KENDRICK LESTER
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:LESTER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-3058
Mailing Address - Country:US
Mailing Address - Phone:504-402-4021
Mailing Address - Fax:
Practice Address - Street 1:5805 6TH ST
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-3058
Practice Address - Country:US
Practice Address - Phone:504-402-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver