Provider Demographics
NPI:1942963087
Name:WILLIAMS, DONNISHE
Entity Type:Individual
Prefix:
First Name:DONNISHE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
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 521
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:AR
Mailing Address - Zip Code:71765-0521
Mailing Address - Country:US
Mailing Address - Phone:870-814-9916
Mailing Address - Fax:
Practice Address - Street 1:255 CLARK STREET
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:AR
Practice Address - Zip Code:71765
Practice Address - Country:US
Practice Address - Phone:870-814-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050502170714E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8678156101Medicaid