Healthcare Provider Details

I. General information

NPI: 1528717881
Provider Name (Legal Business Name): DAVID RAY WILLIAMS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 S WHITBOURNE PL
OKLAHOMA CITY OK
73170-4824
US

IV. Provider business mailing address

2209 S WHITBOURNE PL
OKLAHOMA CITY OK
73170-4824
US

V. Phone/Fax

Practice location:
  • Phone: 405-922-6261
  • Fax:
Mailing address:
  • Phone: 140-592-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0059986
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: