Provider Demographics
NPI:1558613356
Name:WILLIAMS, ANGELA LYNNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 S ASPEN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7501
Mailing Address - Country:US
Mailing Address - Phone:918-455-4140
Mailing Address - Fax:918-455-0170
Practice Address - Street 1:3300 S ASPEN AVE STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7501
Practice Address - Country:US
Practice Address - Phone:918-455-4140
Practice Address - Fax:918-455-0170
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86448363LP0200X
OK20111693363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics