Healthcare Provider Details

I. General information

NPI: 1376830620
Provider Name (Legal Business Name): CHRISTY LYNN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 PHOENIX AVE SUITE B
FORT SMITH AR
72903-5092
US

IV. Provider business mailing address

1 CHILDRENS WAY SLOT 900
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-9091
  • Fax: 479-782-3415
Mailing address:
  • Phone: 501-364-3620
  • Fax: 501-364-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR72567
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: