Provider Demographics
NPI:1457164634
Name:WILLIAMS, KAITLYN N
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:N
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4703 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68157-2646
Mailing Address - Country:US
Mailing Address - Phone:402-541-3999
Mailing Address - Fax:
Practice Address - Street 1:4703 GREENE AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68157-2646
Practice Address - Country:US
Practice Address - Phone:402-541-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
158795374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide