Healthcare Provider Details

I. General information

NPI: 1639373764
Provider Name (Legal Business Name): NACHET J. WILLIAMS-PRINCE MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 TUTU PARK MALL STE 207
ST THOMAS VI
00802-1736
US

IV. Provider business mailing address

PO BOX 11941
ST THOMAS VI
00801-4941
US

V. Phone/Fax

Practice location:
  • Phone: 340-775-3700
  • Fax: 340-777-7927
Mailing address:
  • Phone: 340-775-3700
  • Fax: 340-777-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: