Provider Demographics
NPI:1851334296
Name:WILLIAMS, TRACY S (APN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884
Mailing Address - Country:US
Mailing Address - Phone:405-257-6282
Mailing Address - Fax:405-257-2051
Practice Address - Street 1:JUNCTION OF HWY 270 AND 56
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884
Practice Address - Country:US
Practice Address - Phone:405-257-6282
Practice Address - Fax:405-257-2051
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily