=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578458907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT JOSEPH WILLIAMS PMHNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 1ST ST
-----------------------------------------------------
City | KENNETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63857-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-662-3495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10947 COSMOS DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63123-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-662-3495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2025013208
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------