Provider Demographics
NPI:1942810569
Name:WILLIAMS, ERICKA MARCENE (FNP)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:MARCENE
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 1:7 COUNTY ROAD 468
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-9142
Mailing Address - Country:US
Mailing Address - Phone:251-518-1069
Mailing Address - Fax:
Practice Address - Street 1:1031 NORTHRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-1173
Practice Address - Country:US
Practice Address - Phone:662-365-9305
Practice Address - Fax:662-365-9304
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS903718OtherMISSISSIPPI BOARD OF NURSING (NP LICENSE NUMBER)