=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831911056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | I'LISA BETH WILLIAMS APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2024
-----------------------------------------------------
Last Update Date | 10/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6221 COLONEL GLENN RD STE B
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72204-7731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-509-3019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9508 MEADOW OAK DR
-----------------------------------------------------
City | SHERWOOD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72120-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-837-0081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 230556
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------