Healthcare Provider Details

I. General information

NPI: 1790602266
Provider Name (Legal Business Name): ANNISIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

13214 CHESTNUT FIELD CT
ROSHARON TX
77583-0378
US

V. Phone/Fax

Practice location:
  • Phone: 859-251-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1236102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: