Provider Demographics
NPI:1134806482
Name:WILLIAMS, SHEKENNA RAE
Entity type:Individual
Prefix:MS
First Name:SHEKENNA
Middle Name:RAE
Last Name:WILLIAMS
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 1:5345 HIGHWAY 18 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-9421
Mailing Address - Country:US
Mailing Address - Phone:601-927-0188
Mailing Address - Fax:601-398-2254
Practice Address - Street 1:5345 HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-9421
Practice Address - Country:US
Practice Address - Phone:601-927-0188
Practice Address - Fax:601-398-2254
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801551223175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist