Provider Demographics
NPI:1417511239
Name:WILLIAMS, MATTHEW CHASE (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHASE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-9182
Mailing Address - Country:US
Mailing Address - Phone:601-996-9842
Mailing Address - Fax:
Practice Address - Street 1:12378 STRONG HEART TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4063
Practice Address - Country:US
Practice Address - Phone:601-996-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS895136163W00000X
TN25819363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse