Provider Demographics
NPI:1366942070
Name:WILLIAMS, ASHLEY OMEATTER
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:OMEATTER
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 1:217 JONES ST APT 215
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4060
Mailing Address - Country:US
Mailing Address - Phone:318-426-8103
Mailing Address - Fax:
Practice Address - Street 1:217 JONES ST APT 215
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4060
Practice Address - Country:US
Practice Address - Phone:318-426-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1790283638Medicaid