Provider Demographics
NPI:1508740259
Name:WILLIAMS, KEVIN CLIFFORD
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CLIFFORD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9183 W DESERT INN RD # E101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3549
Mailing Address - Country:US
Mailing Address - Phone:208-312-5854
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD # DTE250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3542
Practice Address - Country:US
Practice Address - Phone:702-982-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV890090163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WH0200XNursing Service ProvidersRegistered NurseHome Health