Healthcare Provider Details

I. General information

NPI: 1942963087
Provider Name (Legal Business Name): DONNISHE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CLARK STREET
STRONG AR
71765
US

IV. Provider business mailing address

PO BOX 521
STRONG AR
71765-0521
US

V. Phone/Fax

Practice location:
  • Phone: 870-814-9916
  • Fax:
Mailing address:
  • Phone: 870-814-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number050502170714E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: