Healthcare Provider Details

I. General information

NPI: 1336646223
Provider Name (Legal Business Name): AMY RUTH WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 COMMERCIAL ST NE STE 17
SALEM OR
97301-3418
US

IV. Provider business mailing address

147 COMMERCIAL ST NE STE 17
SALEM OR
97301-3418
US

V. Phone/Fax

Practice location:
  • Phone: 470-415-1502
  • Fax: 470-415-1502
Mailing address:
  • Phone: 470-415-1502
  • Fax: 971-238-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0030217
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN244037
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10041502
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: