Healthcare Provider Details

I. General information

NPI: 1346977816
Provider Name (Legal Business Name): LACEY REBEKAH WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S PARK ST
ASHEBORO NC
27203-5651
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-6371
  • Fax:
Mailing address:
  • Phone: 336-716-1331
  • Fax: 910-332-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016655
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: