Provider Demographics
NPI:1811000540
Name:WILLIAMS, SANDRA R (CNS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 HIAWATHA TRL
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4405
Mailing Address - Country:US
Mailing Address - Phone:318-640-3262
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY 71 NORTH
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5036
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02638364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult