Provider Demographics
NPI:1023200060
Name:WILLIAMS, STEPHANIE K (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MORRIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055
Mailing Address - Country:US
Mailing Address - Phone:318-377-8260
Mailing Address - Fax:318-377-9053
Practice Address - Street 1:208 MORRIS DRIVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055
Practice Address - Country:US
Practice Address - Phone:318-377-8260
Practice Address - Fax:318-377-9053
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05038363LF0000X
LARN107044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1034975Medicaid
LA1034975Medicaid