Healthcare Provider Details

I. General information

NPI: 1578487732
Provider Name (Legal Business Name): MR. CHRISTOPHER DE'VON WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 BRIGHTON DR
TRACY CA
95376-9380
US

IV. Provider business mailing address

1341 BRIGHTON DR
TRACY CA
95376-9380
US

V. Phone/Fax

Practice location:
  • Phone: 910-224-8552
  • Fax:
Mailing address:
  • Phone: 910-224-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95095980
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: