Provider Demographics
NPI:1487296836
Name:ADAMS, KIZZY WILLIAMS
Entity type:Individual
Prefix:MRS
First Name:KIZZY
Middle Name:WILLIAMS
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-0194
Mailing Address - Country:US
Mailing Address - Phone:225-717-0022
Mailing Address - Fax:
Practice Address - Street 1:54 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2450
Practice Address - Country:US
Practice Address - Phone:225-717-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011136336OtherDRIVERS LICENSE