Provider Demographics
NPI:1780657833
Name:WILLIAMS, PATRICIA GRIMES (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GRIMES
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-679-2661
Mailing Address - Fax:336-679-7056
Practice Address - Street 1:305 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-2661
Practice Address - Fax:336-679-7056
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS90625Medicare UPIN
NCNCM384AMedicare PIN
NC2599054DMedicare PIN