Healthcare Provider Details

I. General information

NPI: 1841650975
Provider Name (Legal Business Name): WILLIAMS NURSE PRACTITIONER GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 9TH ST
MAYFIELD KY
42066-2208
US

IV. Provider business mailing address

110 S 9TH ST
MAYFIELD KY
42066-2208
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-7795
  • Fax: 270-247-9013
Mailing address:
  • Phone: 270-247-7795
  • Fax: 270-247-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6289P
License Number StateKY

VIII. Authorized Official

Name: PATRICIA M. WILLIAMS
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 270-247-7795