Provider Demographics
NPI:1164809737
Name:WILLIAMS, DANIELLE (APRN)
Entity Type:Individual
Prefix:PROF
First Name:DANIELLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:KEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3930 SALVATION RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3332
Mailing Address - Country:US
Mailing Address - Phone:314-449-1143
Mailing Address - Fax:314-449-1724
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-449-1143
Practice Address - Fax:314-449-1724
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015012086363LA2200X
IL209014671363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health