MEDICARE: WILLIAMS NURSE PRACTITIONER GROUP

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	6289P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841650975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMS NURSE PRACTITIONER GROUP

Provider Business Mailing Address
First Line	:	110 S 9TH ST
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-2208
Country	:	US
Telephone Number	:	270-247-7795
Fax Number	:	270-247-9013

Provider Business Practice Location Address
First Line	:	110 S 9TH ST
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-2208
Country	:	US
Telephone Number	:	270-247-7795
Fax Number	:	270-247-9013

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	PATRICIA M. WILLIAMS
Credential	:	MD
Telephone Number	:	270-247-7795

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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