Healthcare Provider Details

I. General information

NPI: 1932080306
Provider Name (Legal Business Name): ANDREA R WILLIAMS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD STE 100
LAWTON OK
73505-6350
US

IV. Provider business mailing address

3201 W GORE BLVD STE 100
LAWTON OK
73505-6350
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-7787
  • Fax: 580-353-5008
Mailing address:
  • Phone: 580-353-7787
  • Fax: 580-353-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number225477
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: