Kejuan Sullivan Williams

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

Practice address

690 Dixie Hwy
Rossford, OH 43460-1221

Phone

(614) 844-3800

NPI assigned

Oct 10, 2018

Last updated

Aug 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661644800000",
    "number": "1003381567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2534 KEY ST APT 3",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436144806",
            "telephone_number": "313-693-0585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 DIXIE HWY",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "434601221",
            "telephone_number": "614-844-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEJUAN",
        "middle_name": "SULLIVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-10",
        "last_updated": "2022-08-28",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE NUMBER",
            "identifier": "W452465778878",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2615030",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Von Der Embse
• Cameryn Paige Warncke
• Latasha Watkins
• Laurie Anne Welsh
• Benjamin Andrew White, DO
• Torriann Shantai Daeshanique Williams
• Anthony Darrell Woodson Jr.
• Victoria Wurzelbacher
• Constance Yager, R.PH.
• Yaya Comes DDS LLC (Yaya Smiles)

• Attendant Care Provider in Rossford, OH
• Providers in Rossford, OH by specialty
• Attendant Care Provider in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.