Healthcare Provider Details

I. General information

NPI: 1124614052
Provider Name (Legal Business Name): CHRISTINA ANN WILLIAMS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S HIGHWAY 65 BLDG A
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

18370 AA HWY
CLARKSBURG MO
65025-2028
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7800
  • Fax: 660-831-3328
Mailing address:
  • Phone: 660-473-0946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020035542
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: