Provider Demographics
NPI:1700411667
Name:WILLIAMS, DUSTIN (NP)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N PRESTON RD STE 329
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3188
Mailing Address - Country:US
Mailing Address - Phone:214-842-9830
Mailing Address - Fax:
Practice Address - Street 1:130 N PRESTON RD STE 329
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3188
Practice Address - Country:US
Practice Address - Phone:214-842-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily