Provider Demographics
NPI:1588055065
Name:WILLIAMS, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
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 1:999 YAMATO RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4477
Mailing Address - Country:US
Mailing Address - Phone:561-325-7810
Mailing Address - Fax:561-952-6911
Practice Address - Street 1:999 YAMATO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4477
Practice Address - Country:US
Practice Address - Phone:561-325-7810
Practice Address - Fax:561-952-6911
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse