Healthcare Provider Details

I. General information

NPI: 1073572061
Provider Name (Legal Business Name): NICOLE WILLIAMS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MEDICAL CENTER DR SUITE #200
MCKINNEY TX
75069-1651
US

IV. Provider business mailing address

5205 ARBOR HOLLOW DR
MCKINNEY TX
75070-6376
US

V. Phone/Fax

Practice location:
  • Phone: 972-547-0352
  • Fax: 972-542-3528
Mailing address:
  • Phone: 972-540-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: