Provider Demographics
NPI:1134887094
Name:WILLIAMS, KAREN ELAINE (FNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 PEYTONS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-3983
Mailing Address - Country:US
Mailing Address - Phone:910-467-5868
Mailing Address - Fax:
Practice Address - Street 1:13304 LEESVILLE CHURCH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-5206
Practice Address - Country:US
Practice Address - Phone:919-845-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWILL-UA1EZ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC195756OtherNORTH CAROLINA BOARD OF NURSING, REGISTERED NURSE