Healthcare Provider Details

I. General information

NPI: 1235883703
Provider Name (Legal Business Name): ALYSSA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

1421 GRANVILLE PL FL 2
SAINT LOUIS MO
63112-4201
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-6500
  • Fax:
Mailing address:
  • Phone: 314-906-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: