Provider Demographics
NPI:1629139407
Name:WILLIAMS, MARY L (GNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:GNP-C
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 272
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0272
Mailing Address - Country:US
Mailing Address - Phone:713-416-8409
Mailing Address - Fax:281-392-9256
Practice Address - Street 1:1480 KATY FLEWELLEN RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6631
Practice Address - Country:US
Practice Address - Phone:713-416-8409
Practice Address - Fax:281-392-9256
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX556795363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8174OtherBCBS
TX178208803Medicaid
TX8K7827Medicare PIN
TX8Y8174OtherBCBS