Provider Demographics
NPI:1578612008
Name:WILLIAMS, PHYLLIS AYCOCK (RN)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:AYCOCK
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-2105
Mailing Address - Country:US
Mailing Address - Phone:910-455-7110
Mailing Address - Fax:910-455-7938
Practice Address - Street 1:615 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5310
Practice Address - Country:US
Practice Address - Phone:910-455-7110
Practice Address - Fax:910-455-7938
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC082155163W00000X, 163WC0400X, 163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC082155OtherREGISTERED NURSE LICENSE
NC5652586OtherDRIVER LICENSE