Basic Information
Provider Information
NPI: 1447715024
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: KAYLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 55050
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722155050
CountryCode: US
TelephoneNumber: 5019063000
FaxNumber: 5019078367
Practice Location
Address1: 8901 CARTI WAY
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722056523
CountryCode: US
TelephoneNumber: 5019063000
FaxNumber: 5019078367
Other Information
ProviderEnumerationDate: 02/07/2019
LastUpdateDate: 03/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XA006119ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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