Healthcare Provider Details

I. General information

NPI: 1902784770
Provider Name (Legal Business Name): MAUDE LYNAE WILLIAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WILHITE DR STE 222
LEXINGTON KY
40503-3385
US

IV. Provider business mailing address

2620 WILHITE DR STE 222
LEXINGTON KY
40503-3385
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8486
  • Fax: 859-278-8488
Mailing address:
  • Phone: 859-278-8486
  • Fax: 859-278-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4045407
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4045407
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: