Provider Demographics
NPI:1225282858
Name:WILLIAMS, AUDRA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LINCOLN OAKS DR S APT 204
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2206
Mailing Address - Country:US
Mailing Address - Phone:918-931-8453
Mailing Address - Fax:
Practice Address - Street 1:1301 N SAGINAW BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-5095
Practice Address - Country:US
Practice Address - Phone:918-931-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080956363LF0000X
TX813218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily