Healthcare Provider Details

I. General information

NPI: 1275033862
Provider Name (Legal Business Name): CAROLYN ANN WILLIAMS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14950 HEATHROW FOREST PKWY
HOUSTON TX
77032-3847
US

IV. Provider business mailing address

19010 TELFORD WAY
TOMBALL TX
77375-2138
US

V. Phone/Fax

Practice location:
  • Phone: 281-921-2301
  • Fax: 281-921-2305
Mailing address:
  • Phone: 214-293-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number123884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: