MEDICARE: THALISSA 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	3747A0650X	Attendant Care Provider
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871425454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THALISSA WILLIAMS

Provider Business Mailing Address
First Line	:	2255 DOGGETT DR # 1122
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-1152
Country	:	US
Telephone Number	:	469-682-7427
Fax Number	:

Provider Business Practice Location Address
First Line	:	8107 MANDERVILLE LN APT 1121
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-3869
Country	:	US
Telephone Number	:	469-682-7427
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ THALISSA WILLIAMS ” Practice Location

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