Healthcare Provider Details

I. General information

NPI: 1164809737
Provider Name (Legal Business Name): DANIELLE WILLIAMS A.P.R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE KEATON

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR STE W1
BELLEVILLE IL
62226-5359
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-3066
  • Fax: 618-233-3180
Mailing address:
  • Phone: 618-233-3066
  • Fax: 618-233-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209014671
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014671
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2015012086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: