Provider Demographics
NPI:1083223879
Name:WILLIAMS, STANISHA NATRICE (PMHNP-BC, AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:STANISHA
Middle Name:NATRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP-BC, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EDEN WAY N STE 118
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:559-375-5913
Mailing Address - Fax:
Practice Address - Street 1:1021 EDEN WAY N STE 118
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2776
Practice Address - Country:US
Practice Address - Phone:757-994-8227
Practice Address - Fax:757-818-9144
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182772363LG0600X, 363LP0808X
NC5013364363LP0808X, 363LP2300X
NJ26NJ01362400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care