Healthcare Provider Details

I. General information

NPI: 1821026071
Provider Name (Legal Business Name): DEBRA LYNN WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW COMMERCE DR
LEES SUMMIT MO
64086-5703
US

IV. Provider business mailing address

701 NW COMMERCE DR
LEES SUMMIT MO
64086-5703
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-3646
  • Fax:
Mailing address:
  • Phone: 816-554-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20956
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: