Individual provider Active NPI

Ronald Rae Williams Jr.

  • Licensed Practical Nurse
  • Las Vegas, NV
National Provider Identifier
1982473039
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
829628 Issued in NV
Practice address
4040 S Eastern Ave
Las Vegas, NV 89119-0810
Phone
(702) 463-0300
Fax
(702) 463-0301
NPI assigned
Dec 29, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X PN268505 PA
Licensed Practical Nurse 164W00000X 829628 NV Primary

Addresses

Primary practice location

4040 S Eastern Ave
Las Vegas, NV 89119-0810

Mailing address

2455 W Serene Ave Unit 639
Las Vegas, NV 89123-6539
Phone (702) 900-5515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
829628NVMDLicensed Practical Nurse
PN268505PAMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1982473039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2455 W SERENE AVE UNIT 639",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891236539",
            "telephone_number": "702-900-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190810",
            "telephone_number": "702-463-0300",
            "fax_number": "702-463-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RONALD",
        "middle_name": "RAE",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-29",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN268505",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NV",
            "license": "829628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.