Healthcare Provider Details

I. General information

NPI: 1053246389
Provider Name (Legal Business Name): LISA WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 CHERI WHITLOCK DR
SILOAM SPRINGS AR
72761-2011
US

IV. Provider business mailing address

23017 WESTPOINT RD
GENTRY AR
72734-8852
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-3191
  • Fax:
Mailing address:
  • Phone: 479-524-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR063963
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: