Provider Demographics
NPI:1629436274
Name:WILLIAMS, EILEEN YVETTE (BSN, RN, NCSN)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:YVETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 SIXTEENTH SECTION RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4700
Mailing Address - Country:US
Mailing Address - Phone:662-323-1446
Mailing Address - Fax:662-324-8463
Practice Address - Street 1:2926 SIXTEENTH SECTION RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4700
Practice Address - Country:US
Practice Address - Phone:662-323-1446
Practice Address - Fax:662-324-8463
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR793333163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool