Provider Demographics
NPI:1689650855
Name:WILLIAMS, CELESTE HOPE (APRN)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:HOPE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 GIBSON STREET
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4221
Mailing Address - Country:US
Mailing Address - Phone:417-256-1006
Mailing Address - Fax:417-256-1007
Practice Address - Street 1:1709 GIBSON STREET
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4221
Practice Address - Country:US
Practice Address - Phone:417-256-1006
Practice Address - Fax:417-256-1007
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS63767Medicare UPIN
MO000081985Medicare ID - Type Unspecified