Healthcare Provider Details

I. General information

NPI: 1053424093
Provider Name (Legal Business Name): REGINA A WILLIAMS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR
TYLERTOWN MS
39667-2020
US

IV. Provider business mailing address

PO BOX 677
TYLERTOWN MS
39667-0677
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-5303
  • Fax: 601-876-0653
Mailing address:
  • Phone: 601-876-5303
  • Fax: 601-876-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR567396
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: