Healthcare Provider Details

I. General information

NPI: 1285822767
Provider Name (Legal Business Name): NANCY ANN WILLIAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY HUTCHINSON D.O.

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROOKS ST
BROOKFIELD MO
64628-1727
US

IV. Provider business mailing address

125 E BROOKS ST
BROOKFIELD MO
64628-1727
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-9065
  • Fax:
Mailing address:
  • Phone: 660-258-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number30110
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30110
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: