Healthcare Provider Details

I. General information

NPI: 1699762724
Provider Name (Legal Business Name): KITZA P WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E CORBIN ST
HILLSBOROUGH NC
27278-2104
US

IV. Provider business mailing address

101 E CORBIN ST
HILLSBOROUGH NC
27278-2104
US

V. Phone/Fax

Practice location:
  • Phone: 919-643-7603
  • Fax: 919-643-7607
Mailing address:
  • Phone: 919-643-7603
  • Fax: 919-643-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200903
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: