Healthcare Provider Details

I. General information

NPI: 1134667355
Provider Name (Legal Business Name): MICHAEL A WILLIAMS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 W GATE BLVD STE 106
AUSTIN TX
78745-1420
US

IV. Provider business mailing address

4534 W GATE BLVD STE 106
AUSTIN TX
78745-1420
US

V. Phone/Fax

Practice location:
  • Phone: 512-840-1273
  • Fax:
Mailing address:
  • Phone: 512-840-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6883
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1030806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: