Provider Demographics
NPI:1417528316
Name:WILLIAMS, HALLIE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 NICHOLAS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8627
Mailing Address - Country:US
Mailing Address - Phone:817-371-0225
Mailing Address - Fax:
Practice Address - Street 1:413 W BETHEL RD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4476
Practice Address - Country:US
Practice Address - Phone:972-393-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant