Healthcare Provider Details

I. General information

NPI: 1649332156
Provider Name (Legal Business Name): CHERYL G WILLIAMS DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 S EAST ST
MOUNT VERNON MO
65712-1331
US

IV. Provider business mailing address

1011 S EAST ST
MOUNT VERNON MO
65712-1331
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-7191
  • Fax: 417-466-3876
Mailing address:
  • Phone: 417-466-7191
  • Fax: 417-466-3876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number113916
License Number StateMO

VIII. Authorized Official

Name: KIM K ROBERTS
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-466-7191