Healthcare Provider Details

I. General information

NPI: 1144790189
Provider Name (Legal Business Name): WILLIAMS HEALTH - NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E 149TH ST STE 8
BRONX NY
10451-5602
US

IV. Provider business mailing address

316 E 149TH ST
BRONX NY
10451-5602
US

V. Phone/Fax

Practice location:
  • Phone: 718-496-7286
  • Fax: 718-671-8030
Mailing address:
  • Phone: 718-496-7286
  • Fax: 718-671-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY MONIQUE WILLIAMS
Title or Position: OWNER
Credential: FNP, PMHNP
Phone: 718-496-7286