Healthcare Provider Details

I. General information

NPI: 1871548008
Provider Name (Legal Business Name): MELINDA T WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ELDAD RD
FAYETTEVILLE TN
37334-7005
US

IV. Provider business mailing address

PO BOX 1118
FAYETTEVILLE TN
37334-1118
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-8260
  • Fax: 931-438-8257
Mailing address:
  • Phone: 931-438-8260
  • Fax: 931-438-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number67538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: