Healthcare Provider Details

I. General information

NPI: 1205809563
Provider Name (Legal Business Name): NANCY JEAN WILLIAMS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKEVIEW DR SUITE 100
COVINGTON LA
70433-7511
US

IV. Provider business mailing address

28 PARK PLACE DR APT 1405
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-1940
  • Fax:
Mailing address:
  • Phone: 865-765-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number12388
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP06294
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: