Healthcare Provider Details

I. General information

NPI: 1043633183
Provider Name (Legal Business Name): TERRICA TERRELL WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9118 BLUEBONNET CENTRE BLVD FL 2
BATON ROUGE LA
70809-2993
US

IV. Provider business mailing address

9118 BLUEBONNET CENTRE BLVD FL 2
BATON ROUGE LA
70809-2993
US

V. Phone/Fax

Practice location:
  • Phone: 225-368-2311
  • Fax: 225-368-2280
Mailing address:
  • Phone: 225-368-2311
  • Fax: 225-368-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberAP07608
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP07608
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: