Provider Demographics
NPI:1215498456
Name:WILLIAMS, TANYA G
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4311
Mailing Address - Country:US
Mailing Address - Phone:580-763-6017
Mailing Address - Fax:
Practice Address - Street 1:401 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-6631
Practice Address - Country:US
Practice Address - Phone:918-847-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator