Provider Demographics
NPI:1235417759
Name:WILLIAMS, MARY SUSAN (ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7300 ELDORADO PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7896
Mailing Address - Country:US
Mailing Address - Phone:972-372-4505
Mailing Address - Fax:855-867-7973
Practice Address - Street 1:7300 ELDORADO PKWY STE 230
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7896
Practice Address - Country:US
Practice Address - Phone:972-372-4505
Practice Address - Fax:855-867-7973
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX748132363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
358354YUNTMedicare PIN