1013457969 NPI number — KORI RAEANN WILLIAMS FNP

Table of content: KORI RAEANN WILLIAMS FNP (NPI 1013457969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013457969 NPI number — KORI RAEANN WILLIAMS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KORI
Provider Middle Name:
RAEANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013457969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 WOODBRIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93306-7035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-428-7456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8307 BRIMHALL RD
Provider Second Line Business Practice Location Address:
STE 1707
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-587-8990
Provider Business Practice Location Address Fax Number:
661-587-8980
Provider Enumeration Date:
02/26/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  95004591 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)