Provider Demographics
NPI:1437938701
Name:WILLIAMS, KAYLA PRUITT (CST, CSFA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:PRUITT
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 HIGHWAY 6 # 150
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4401
Mailing Address - Country:US
Mailing Address - Phone:832-648-3306
Mailing Address - Fax:
Practice Address - Street 1:6544 GREATWOOD PWKY
Practice Address - Street 2:STE A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:832-648-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191336246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist