1487661245 NPI number — REBECCA R WILLIAMS PA

Table of content: REBECCA R WILLIAMS PA (NPI 1487661245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487661245 NPI number — REBECCA R WILLIAMS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
REBECCA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487661245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 N MONTE VISTA ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-436-7101
Provider Business Mailing Address Fax Number:
580-436-4447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 MEMORIAL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73142-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-749-7099
Provider Business Practice Location Address Fax Number:
405-216-5872
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1290 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1290 . This is a "PHYSICIAN ASSISTANTS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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