Provider Demographics
NPI:1588055289
Name:WILLIAMS, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
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:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-0925
Mailing Address - Country:US
Mailing Address - Phone:276-385-5688
Mailing Address - Fax:
Practice Address - Street 1:57 MIDTOWN CIR
Practice Address - Street 2:BOX 925
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-385-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401121322376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide