1770041691 NPI number — GENOVA L WILLIAMS APRN, FNP-C

Table of content: GENOVA L WILLIAMS APRN, FNP-C (NPI 1770041691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770041691 NPI number — GENOVA L WILLIAMS APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
GENOVA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
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:
1770041691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4196 HIGHWAY 62 412 STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72542-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 WOODRUFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADLEY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71826-8715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-330-6060
Provider Business Practice Location Address Fax Number:
501-468-0497
Provider Enumeration Date:
03/10/2019

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: 363LF0000X , with the licence number:  AP136038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F11170086 . This is a "AANP FNP CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803397 . This is a "RN LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AP136038 . This is a "APRN LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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