=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841816964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNALEE FRANCES WILLIAMS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2020
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 W TERRELL AVE N
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-820-0427
-----------------------------------------------------
Fax | 817-820-0431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 WESTPARK WAY
-----------------------------------------------------
City | EULESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76040-3963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-488-8998
-----------------------------------------------------
Fax | 855-295-2686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA13738
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------