Provider Demographics
NPI:1326771650
Name:WILLIAMS, ALYCIA PARKER (PA)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:PARKER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PERFECT PL
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6444
Mailing Address - Country:US
Mailing Address - Phone:318-415-8008
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PLAZA PL
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3330
Practice Address - Country:US
Practice Address - Phone:183-772-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty