Healthcare Provider Details

I. General information

NPI: 1548793011
Provider Name (Legal Business Name): CARRERA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4927
US

IV. Provider business mailing address

5 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4927
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-9188
  • Fax: 573-335-1838
Mailing address:
  • Phone: 573-335-9188
  • Fax: 573-335-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017010496
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: