=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629924253
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTAL DEANNE WILLIAMS AGPCNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2026
-----------------------------------------------------
Last Update Date | 03/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 N HILL ST STE 5
-----------------------------------------------------
City | TATUM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75691-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-947-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 JEFFERSON ST
-----------------------------------------------------
City | BECKVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75631-1746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-824-4847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 1226746
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1226746
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------