Healthcare Provider Details

I. General information

NPI: 1316856685
Provider Name (Legal Business Name): ELI WALKER WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
CAPE GIRARDEAU MO
63701-4710
US

IV. Provider business mailing address

431 OLIVE ST APT 3
CAPE GIRARDEAU MO
63701-6904
US

V. Phone/Fax

Practice location:
  • Phone: 573-986-6841
  • Fax:
Mailing address:
  • Phone: 731-926-0216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: