Provider Demographics
NPI:1477900611
Name:WILLIAMS, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ARKANSAS HIGHWAY 115
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9332
Mailing Address - Country:US
Mailing Address - Phone:870-994-3103
Mailing Address - Fax:870-994-3108
Practice Address - Street 1:2040 FITZHUGH ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7409
Practice Address - Country:US
Practice Address - Phone:870-793-3334
Practice Address - Fax:870-793-3334
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist