Healthcare Provider Details

I. General information

NPI: 1548172943
Provider Name (Legal Business Name): BRYNNA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 FOUR STATES DR
GALENA KS
66739-4324
US

IV. Provider business mailing address

3443 ANTELOPE RD
JOPLIN MO
64804-8926
US

V. Phone/Fax

Practice location:
  • Phone: 877-783-4441
  • Fax:
Mailing address:
  • Phone: 417-438-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2019026930
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: