Provider Demographics
NPI:1861826968
Name:WILLIAMS, LADONNA JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 EAST STATE HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873
Mailing Address - Country:US
Mailing Address - Phone:573-391-8031
Mailing Address - Fax:573-391-8050
Practice Address - Street 1:46 E STATE HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63873-9177
Practice Address - Country:US
Practice Address - Phone:573-359-1372
Practice Address - Fax:573-359-3520
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026043363LF0000X
MO2019011201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily