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NPI Code Detail

MEDICARE: DEASHANDREA THOMAS WILLIAMS MSN, RN, FNP-C

MEDICARE: DEASHANDREA THOMAS WILLIAMS MSN, RN, FNP-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
1363LF0000XFamily Nurse PractitionerAP139180TX

General Provider Information

NPI Number : 1114492568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEASHANDREA THOMAS WILLIAMS MSN, RN, FNP-C
Provider Business Mailing Address
First Line : 50 S B B KING BLVD # 100
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-2626
Country : US
Telephone Number : 901-436-1381
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 888-608-0499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2018
Last Update Date : 10/03/2022

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