Healthcare Provider Details

I. General information

NPI: 1811000540
Provider Name (Legal Business Name): SANDRA R WILLIAMS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY 71 NORTH
PINEVILLE LA
71360
US

IV. Provider business mailing address

312 HIAWATHA TRL
PINEVILLE LA
71360-4405
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax: 318-483-5036
Mailing address:
  • Phone: 318-640-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP02638
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: