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NPI Code Detail

MEDICARE: CARRIE WILLIAMS

MEDICARE: CARRIE WILLIAMS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1790493393
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE WILLIAMS
Provider Business Mailing Address
First Line : 102 E BROADWAY ST
Second Line :
City : UNION CITY
State : OK
Zip : 73090-9402
Country : US
Telephone Number : 405-494-5229
Fax Number :
Provider Business Practice Location Address
First Line : 7777 E US HIGHWAY 66
Second Line :
City : EL RENO
State : OK
Zip : 73036-9125
Country : US
Telephone Number : 405-424-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2022
Last Update Date : 11/11/2022

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