Healthcare Provider Details

I. General information

NPI: 1518402841
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL WILLIAMS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 500 W BLDG A
PROVO UT
84604-3305
US

IV. Provider business mailing address

1055 N. 500 W. ATTN CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 801-812-5034
  • Fax: 801-812-5034
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6790017-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: