MEDICARE: MARLO S. WILLIAMS

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	363LF0000X	Family Nurse Practitioner	A004586	AR

General Provider Information

NPI Number	:	1174981104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLO S. WILLIAMS

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:	870-347-1235

Provider Business Practice Location Address
First Line	:	1028 N MISSOURI ST STE 6
Second Line	:
City	:	WEST MEMPHIS
State	:	AR
Zip	:	72301-2600
Country	:	US
Telephone Number	:	870-400-0263
Fax Number	:	870-400-0293

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

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	01/19/2022

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Directions to “ MARLO S. WILLIAMS ” Practice Location

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