Provider Demographics
NPI:1912520230
Name:WILLIAMS, MISTY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:WELDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 S VALLEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35961-3263
Mailing Address - Country:US
Mailing Address - Phone:256-524-3090
Mailing Address - Fax:256-524-2885
Practice Address - Street 1:52 S VALLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35961-3263
Practice Address - Country:US
Practice Address - Phone:256-524-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1117476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1117476OtherBOARD OF NURSING