Provider Demographics
NPI:1093051872
Name:WILLIAMS, KHOSHUNDA MONIQUE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KHOSHUNDA
Middle Name:MONIQUE
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:PO BOX 844273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4273
Mailing Address - Country:US
Mailing Address - Phone:903-534-9041
Mailing Address - Fax:
Practice Address - Street 1:1001 N PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-4122
Practice Address - Country:US
Practice Address - Phone:903-904-5084
Practice Address - Fax:903-904-5085
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122645363LF0000X, 363LP2300X
TX653746363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily