Provider Demographics
NPI:1003670191
Name:WILLIAMS, DEVON K (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-8960
Mailing Address - Country:US
Mailing Address - Phone:760-562-6439
Mailing Address - Fax:
Practice Address - Street 1:1550 N IMPERIAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6304
Practice Address - Country:US
Practice Address - Phone:760-353-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950290003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily