Healthcare Provider Details

I. General information

NPI: 1689984783
Provider Name (Legal Business Name): JOHN L WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S OSTEOPATHY AVE
KIRKSVILLE MO
63501-6401
US

IV. Provider business mailing address

907 DEAR ST
KIRKSVILLE MO
63501-2607
US

V. Phone/Fax

Practice location:
  • Phone: 660-785-1098
  • Fax: 660-665-0333
Mailing address:
  • Phone: 719-244-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11004661
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2010033248
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: