Provider Demographics
NPI:1285822767
Name:WILLIAMS, NANCY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:125 E BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-1727
Mailing Address - Country:US
Mailing Address - Phone:660-258-9065
Mailing Address - Fax:
Practice Address - Street 1:125 E BROOKS ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-1727
Practice Address - Country:US
Practice Address - Phone:660-258-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO30110207K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240728717Medicaid
120002207OtherRAILROAD MEDICARE
MO240728717Medicaid
MO001013817Medicare PIN