Provider Demographics
NPI:1104365469
Name:WILLIAMS, CRYSTAL (APN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
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 1:326 N LOCUST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3516
Mailing Address - Country:US
Mailing Address - Phone:931-762-9797
Mailing Address - Fax:931-762-9798
Practice Address - Street 1:326 N LOCUST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3516
Practice Address - Country:US
Practice Address - Phone:931-762-9797
Practice Address - Fax:931-762-9798
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122807163W00000X
TN22271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse