Healthcare Provider Details

I. General information

NPI: 1013850346
Provider Name (Legal Business Name): BRANDIE NICHOLE WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6294 STATE HIGHWAY 154
SESSER IL
62884-2163
US

IV. Provider business mailing address

6294 STATE HIGHWAY 154
SESSER IL
62884-2163
US

V. Phone/Fax

Practice location:
  • Phone: 618-625-6979
  • Fax: 618-625-6549
Mailing address:
  • Phone: 618-625-6979
  • Fax: 618-625-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035895
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209035895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: