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General NPI Number Information
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NPI Number | 1689145591
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Entity Type | Individual
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Provider Name | SHANNA M WILLIAMS PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 2302 CHESTER BLVD STE A
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City | RICHMOND
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State | IN
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Zip | 47374-1221
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Country | US
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Telephone | 765-488-0345
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Fax | 765-488-2467
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Provider Business Mailing Address
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Address Line | 312 N UNION ST
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City | UNION CITY
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State | IN
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Zip | 47390-1422
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Country | US
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Telephone | 937-467-3986
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005816RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002597A
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License Number State | IN
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