1942774088 NPI number — ERICA EVANGELINE WILLIAMS PA-C

Table of content: ERICA EVANGELINE WILLIAMS PA-C (NPI 1942774088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942774088 NPI number — ERICA EVANGELINE WILLIAMS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
ERICA
Provider Middle Name:
EVANGELINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRATE
Provider Other First Name:
ERICA
Provider Other Middle Name:
EVANGELINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942774088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 HAWKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEARCY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72143-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-278-3007
Provider Business Mailing Address Fax Number:
501-278-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 HAWKINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-278-3007
Provider Business Practice Location Address Fax Number:
501-278-3050
Provider Enumeration Date:
01/11/2019

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: 207RS0012X , with the licence number:  PA-825 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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