Provider Demographics
NPI:1508453671
Name:WILLIAMS, LAURA (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 ROUTE BB
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:MO
Mailing Address - Zip Code:65032-2128
Mailing Address - Country:US
Mailing Address - Phone:660-216-2290
Mailing Address - Fax:
Practice Address - Street 1:3605 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1070
Practice Address - Country:US
Practice Address - Phone:573-634-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily