Provider Demographics
NPI:1205323904
Name:WILLIAMS, JATOYA KASHETTLYN
Entity type:Individual
Prefix:MS
First Name:JATOYA
Middle Name:KASHETTLYN
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 1:215 ORANGE GROVE
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3382
Mailing Address - Country:US
Mailing Address - Phone:337-321-5513
Mailing Address - Fax:337-364-7261
Practice Address - Street 1:215 ORANGE GROVE
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3382
Practice Address - Country:US
Practice Address - Phone:337-321-5513
Practice Address - Fax:337-364-7261
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
123322374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide