Provider Demographics
NPI:1881131464
Name:WILLIAMS, KEVIN CHRISTIAN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTIAN
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 1:1422 LANDER ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2656
Mailing Address - Country:US
Mailing Address - Phone:775-722-3385
Mailing Address - Fax:
Practice Address - Street 1:90 GAULT WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2322
Practice Address - Country:US
Practice Address - Phone:775-722-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant