MEDICARE: MATTHEW CHASE WILLIAMS APRN

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	163W00000X	Registered Nurse	895136	MS
2	363L00000X	Nurse Practitioner	10054216	OR
3	363L00000X	Nurse Practitioner	25819	TN

General Provider Information

NPI Number	:	1417511239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHASE WILLIAMS APRN

Provider Business Mailing Address
First Line	:	2044 BARNETT RD
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9182
Country	:	US
Telephone Number	:	601-996-9842
Fax Number	:

Provider Business Practice Location Address
First Line	:	12378 STRONG HEART TRL
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4063
Country	:	US
Telephone Number	:	601-996-9842
Fax Number	:

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

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	06/09/2026

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