Provider Demographics
NPI:1013944800
Name:WILLIAMS, DOUGLAS (ARNP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CELINA ROAD
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717
Mailing Address - Country:US
Mailing Address - Phone:270-433-1241
Mailing Address - Fax:
Practice Address - Street 1:299A GLASGOW RD
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-9696
Practice Address - Country:US
Practice Address - Phone:270-864-2555
Practice Address - Fax:270-864-3777
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004378363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014073Medicaid