Provider Demographics
NPI:1952416828
Name:WILLIAMS, BRENDA L (RN,PNP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 US HWY 75 S, SUITE 300
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:806-351-7540
Mailing Address - Fax:
Practice Address - Street 1:1900 SE 34TH AVE
Practice Address - Street 2:UNIT 1800
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-7771
Practice Address - Country:US
Practice Address - Phone:806-468-4673
Practice Address - Fax:806-468-4572
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231174363LP0200X
TXAP103529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467284Medicaid
TX1467284Medicaid