Provider Demographics
NPI:1477184299
Name:WILLIAMS, TREACY (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TREACY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3130
Mailing Address - Country:US
Mailing Address - Phone:636-432-5500
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3130
Practice Address - Country:US
Practice Address - Phone:636-432-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health