Provider Demographics
NPI:1053532770
Name:WILLIAMS, DEIDRA RACHELLE (LPN)
Entity type:Individual
Prefix:MISS
First Name:DEIDRA
Middle Name:RACHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 W REESE GROVE CT
Mailing Address - Street 2:#201
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8533
Mailing Address - Country:US
Mailing Address - Phone:901-577-0200
Mailing Address - Fax:901-577-0207
Practice Address - Street 1:2531 W REESE GROVE CT
Practice Address - Street 2:#201
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-8533
Practice Address - Country:US
Practice Address - Phone:901-577-0200
Practice Address - Fax:901-577-0207
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL45702164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse