Provider Demographics
NPI:1164807798
Name:WILLIAMS, MARY LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LINDSEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LINDSEY
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1221 E STATE HIGHWAY 114 STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6401
Mailing Address - Country:US
Mailing Address - Phone:817-251-9280
Mailing Address - Fax:817-251-4959
Practice Address - Street 1:1221 E STATE HIGHWAY 114 STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6401
Practice Address - Country:US
Practice Address - Phone:817-251-9280
Practice Address - Fax:817-251-4959
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily