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NPI Code Detail

MEDICARE: JORDAN LACY WILLIAMS CRNA

MEDICARE: JORDAN LACY WILLIAMS CRNA
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
1367500000XCertified Registered Nurse Anesthetist1046041TX
2367500000XCertified Registered Nurse Anesthetist133644TX

General Provider Information

NPI Number : 1629645353
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LACY WILLIAMS CRNA
Provider Business Mailing Address
First Line : 6501 FANNIN ST STE NC114
Second Line : BCM120
City : HOUSTON
State : TX
Zip : 77030-2703
Country : US
Telephone Number : 713-798-7356
Fax Number : 972-233-3666
Provider Business Practice Location Address
First Line : 6720 BERTNER AVE
Second Line :
City : HOUSTON
State : TX
Zip : 77030-2604
Country : US
Telephone Number : 832-355-2666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 04/17/2026

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Directions to “ JORDAN LACY WILLIAMS CRNA” Practice Location

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