=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336926054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2023
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 FITZWATER RD
-----------------------------------------------------
City | LIZEMORE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-444-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 73
-----------------------------------------------------
City | CLAY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25043-0073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-444-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------