Healthcare Provider Details

I. General information

NPI: 1003670191
Provider Name (Legal Business Name): DEVON K WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N IMPERIAL AVE STE 1
EL CENTRO CA
92243-6304
US

IV. Provider business mailing address

525 MESQUITE ST
IMPERIAL CA
92251-8960
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-4710
  • Fax:
Mailing address:
  • Phone: 760-562-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number950290003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: