Provider Demographics
NPI:1750999413
Name:WILLIAMS, STACI Y (CFNP)
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:Y
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 SW LEE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9651
Mailing Address - Country:US
Mailing Address - Phone:580-536-6600
Mailing Address - Fax:
Practice Address - Street 1:5606 SW LEE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9651
Practice Address - Country:US
Practice Address - Phone:580-536-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85520363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care