Healthcare Provider Details

I. General information

NPI: 1740582279
Provider Name (Legal Business Name): MS. CASARA NICHOLE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 12/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 OLIVE HILL DR
MABELVALE AR
72103-3847
US

IV. Provider business mailing address

11016 CHARLOTTE DR
MABELVALE AR
72103-3054
US

V. Phone/Fax

Practice location:
  • Phone: 501-612-1876
  • Fax:
Mailing address:
  • Phone: 501-352-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number918660211
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: