Provider Demographics
NPI:1770041691
Name:WILLIAMS, GENOVA L (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:GENOVA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2980
Mailing Address - Country:US
Mailing Address - Phone:903-614-5355
Mailing Address - Fax:903-614-5399
Practice Address - Street 1:5002 COWHORN CREEK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-9766
Practice Address - Country:US
Practice Address - Phone:903-614-3282
Practice Address - Fax:903-614-3525
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11170086OtherAANP FNP CERTIFICATION NUMBER
TX803397OtherRN LICENSE NUMBER
TXAP136038OtherAPRN LICENSE NUMBER