Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95004591 | CA |
NPI | 1013457969 |
---|---|
Provider Name | Kori Raeann Williams |
First Address | Bakersfield, CA 93306-7035 |
Second Address | Bakersfield, CA 93312-2251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2017 |
Last Update Date | 14/05/2019 |