Individual ProviderKevin L WilliamsNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1455 E Bert Kouns Loop, Suite #100, Shreveport, LA 71105-5634(318) 798-4596PECOS EnrollmentBased on the most recent information from CMS, provider Kevin L Williams does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1225309545Provider TypeIndividualFull NameWilliams, Kevin LCredentialCRNAGenderMaleSole ProprietorNoEnumeration Date1/18/2012Last Updated5/24/2013Contact InformationPractice LocationPractice Address1455 E Bert Kouns Loop, Suite #100, Shreveport, LA 71105-5634Phone(318) 798-4596Fax(318) 798-4520Mailing LocationMailing Address1455 E Bert Kouns Loop, Suite #100, Shreveport, LA 71105-5634Phone(318) 798-4596Fax(318) 798-4520Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseRN134889LouisianaProvider IdentifiersIDDescriptionIssuerID298034401DescriptionMedicaidIssuerUnlistedTexasID8398UCDescriptionOtherIssuerBCBSTexasID750818167015DescriptionOtherIssuerTRICARETexas