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General NPI Number Information
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NPI Number | 1326531690
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Entity Type | Individual
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Provider Name | KAREN LARISSA WILLIAMS APRN
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 3100 S ELM PL STE B
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City | BROKEN ARROW
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State | OK
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Zip | 74012-7950
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Country | US
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Telephone | 918-884-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 13408 S 20TH CT
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City | BIXBY
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State | OK
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Zip | 74008-1029
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Country | US
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Telephone | 904-735-7749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 109297
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License Number State | OK
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