MEDICARE: MISS NATALIE SHEA WILLIAMS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10242	TX

General Provider Information

NPI Number	:	1053785568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATALIE SHEA WILLIAMS PA-C

Provider Business Mailing Address
First Line	:	1020 E IDEL ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2024
Country	:	US
Telephone Number	:	903-535-2902
Fax Number	:	903-535-9217

Provider Business Practice Location Address
First Line	:	1020 E IDEL ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2024
Country	:	US
Telephone Number	:	903-535-2902
Fax Number	:	903-535-9217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	01/16/2020

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