Provider Demographics
NPI:1013369404
Name:WILLIAMS, MANDI T (APN)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-3112
Mailing Address - Country:US
Mailing Address - Phone:479-739-1063
Mailing Address - Fax:
Practice Address - Street 1:7217 CAMERON PARK DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6167
Practice Address - Country:US
Practice Address - Phone:479-831-6007
Practice Address - Fax:479-782-1242
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004812363LP0200X, 363LP0808X
AR004812363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health