Provider Demographics
NPI:1578947925
Name:WILLIAMS, MARY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 MC 152
Mailing Address - Street 2:
Mailing Address - City:DODDRIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:71834-1695
Mailing Address - Country:US
Mailing Address - Phone:903-277-9705
Mailing Address - Fax:
Practice Address - Street 1:1205 E 35TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2746
Practice Address - Country:US
Practice Address - Phone:903-614-5355
Practice Address - Fax:903-614-5399
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily