Healthcare Provider Details

I. General information

NPI: 1881067437
Provider Name (Legal Business Name): BETSY WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807-3623
US

IV. Provider business mailing address

4335 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807-3623
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3867
  • Fax: 865-992-7238
Mailing address:
  • Phone: 865-992-3867
  • Fax: 865-992-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000200971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: