Healthcare Provider Details

I. General information

NPI: 1639610256
Provider Name (Legal Business Name): A'BRIEL WILLIAMS MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LEE AVE
EARLE AR
72331-2159
US

IV. Provider business mailing address

703 CALVIN AVERY DR
WEST MEMPHIS AR
72301-6501
US

V. Phone/Fax

Practice location:
  • Phone: 870-792-7769
  • Fax:
Mailing address:
  • Phone: 870-732-1878
  • Fax: 870-702-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: