Provider Demographics
NPI:1093798050
Name:WILLIAMS, DWIGHT C (CRNA)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA
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 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:608 N KEY AVE
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1106
Practice Address - Country:US
Practice Address - Phone:512-556-3682
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569558367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281360OtherSCOTT & WHITE
TX109960803Medicaid
TX126922101OtherFIRST CARE
TX742933806OtherTRICARE
TX126101500OtherDEPARTMENT OF LABOR
TX109960803OtherSUPERIOR HEALTH CHIP
TX00030COtherBCBS
TX109960803Medicaid