Provider Demographics
NPI:1609098979
Name:WILLIAMS, AVERY LA-MONT (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:AVERY
Middle Name:LA-MONT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1847
Mailing Address - Country:US
Mailing Address - Phone:405-278-1573
Mailing Address - Fax:
Practice Address - Street 1:3029 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1847
Practice Address - Country:US
Practice Address - Phone:405-278-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0070988163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)