Provider Demographics
NPI:1932665049
Name:JAMES, KISHA WILLIAMS
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:WILLIAMS
Last Name:JAMES
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 1:10839 N RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1758
Mailing Address - Country:US
Mailing Address - Phone:833-444-8500
Mailing Address - Fax:225-800-1070
Practice Address - Street 1:15446 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1575
Practice Address - Country:US
Practice Address - Phone:225-788-3822
Practice Address - Fax:225-800-1070
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
LARN099376163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)