Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | A004812 | AR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | A004812 | AR |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 004812 | AR |
NPI | 1013369404 |
---|---|
Provider Name | Mandi T Williams |
First Address | Greenwood, AR 72936-3112 |
Second Address | Fort Smith, AR 72903-6167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 01/10/2019 |