Healthcare Provider Details

I. General information

NPI: 1306217856
Provider Name (Legal Business Name): ERIN WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1618
US

IV. Provider business mailing address

46 WEXFORD CV
HUMBOLDT TN
38343-8649
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6915
  • Fax: 731-668-4557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20584
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: