Provider Demographics
NPI:1639765373
Name:LONGINOTTI WILLIAMS APRN SERVICES PLLC
Entity Type:Organization
Organization Name:LONGINOTTI WILLIAMS APRN SERVICES PLLC
Other - Org Name:ASSURANCE HEALTH & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:501-219-1929
Mailing Address - Street 1:3858 FREEDOM CV
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-9750
Mailing Address - Country:US
Mailing Address - Phone:501-831-0381
Mailing Address - Fax:
Practice Address - Street 1:11215 HERMITAGE RD STE 103
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3863
Practice Address - Country:US
Practice Address - Phone:501-219-1929
Practice Address - Fax:501-219-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176962758Medicaid
AR269027762Medicaid
ARA003231OtherARKANSAS NURSING LICENSE