Provider Demographics
NPI:1275061509
Name:WILLIAMS, BRANDI ELAINE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 TURMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8998
Mailing Address - Country:US
Mailing Address - Phone:870-819-0200
Mailing Address - Fax:
Practice Address - Street 1:3214 WINCHESTER
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2929
Practice Address - Country:US
Practice Address - Phone:501-326-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist