Healthcare Provider Details

I. General information

NPI: 1992295737
Provider Name (Legal Business Name): MARISSA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-8862
US

IV. Provider business mailing address

200 MAROON LN
KYLE TX
78640-2394
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-1111
  • Fax:
Mailing address:
  • Phone: 860-912-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP140647
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: