Provider Demographics
NPI:1003900804
Name:WILLIAMS, VICKI JEAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HOLLY HALL
Mailing Address - Street 2:ROOM 211
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-566-6640
Mailing Address - Fax:713-566-6635
Practice Address - Street 1:10702 EAST HARDY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093
Practice Address - Country:US
Practice Address - Phone:713-696-2731
Practice Address - Fax:713-696-2735
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153731801Medicaid
TX84P285Medicare ID - Type Unspecified
TX153731801Medicaid