Provider Demographics
NPI:1972014280
Name:WILLIAMS, KERRY LORTON (CNA/ CHHA)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LORTON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA/ CHHA
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:NILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13819 PERRIN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5268
Mailing Address - Country:US
Mailing Address - Phone:317-379-5766
Mailing Address - Fax:
Practice Address - Street 1:1305 CUMBERLAND AVE STE 225
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1343
Practice Address - Country:US
Practice Address - Phone:317-379-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
IN0201251374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator