MEDICARE: MRS. TERI WILLIAMS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	907988	MS

General Provider Information

NPI Number	:	1063375046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERI WILLIAMS FNP

Provider Business Mailing Address
First Line	:	1202 US-49
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614
Country	:	US
Telephone Number	:	662-209-1202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 US-49
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614
Country	:	US
Telephone Number	:	662-209-1202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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