Healthcare Provider Details

I. General information

NPI: 1093798050
Provider Name (Legal Business Name): DWIGHT C WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 N KEY AVE
LAMPASAS TX
76550-1106
US

IV. Provider business mailing address

PO BOX 938
KILLEEN TX
76540-0938
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-3682
  • Fax: 254-200-4090
Mailing address:
  • Phone: 254-634-6999
  • Fax: 254-200-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number569558
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: