Provider Demographics
NPI:1639745904
Name:WILLIAMS, ELLEN PETERS (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PETERS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:AL
Mailing Address - Zip Code:35616-6339
Mailing Address - Country:US
Mailing Address - Phone:256-412-1344
Mailing Address - Fax:
Practice Address - Street 1:1896 HIGHWAY 471
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7964
Practice Address - Country:US
Practice Address - Phone:601-665-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health