Healthcare Provider Details

I. General information

NPI: 1073234456
Provider Name (Legal Business Name): EMILY JULIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DRIVE
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

10094 BENT CREEK DR
LOVELAND OH
45140-4801
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2465
  • Fax: 859-301-4941
Mailing address:
  • Phone: 513-476-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC097
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.008470RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: