Healthcare Provider Details

I. General information

NPI: 1336876721
Provider Name (Legal Business Name): BRADEN WILLIAMS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W GARDEN ST
PEORIA IL
61605-3531
US

IV. Provider business mailing address

2214 N UNIVERSITY ST
PEORIA IL
61604-3221
US

V. Phone/Fax

Practice location:
  • Phone: 309-680-7600
  • Fax:
Mailing address:
  • Phone: 309-680-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009850
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: