Healthcare Provider Details

I. General information

NPI: 1780980847
Provider Name (Legal Business Name): CELESTE SARENE WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W CENTERTON BLVD
CENTERTON AR
72719-9705
US

IV. Provider business mailing address

1225E CENTERTON BLVD
CENTERTON AR
72719
US

V. Phone/Fax

Practice location:
  • Phone: 479-795-1301
  • Fax: 479-795-1304
Mailing address:
  • Phone: 479-795-1301
  • Fax: 479-795-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA003510
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: