Provider Demographics
NPI:1316329360
Name:WILLIAMS, SAMANTHA FAYE (CNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12067 PAUL EELLS DR
Mailing Address - Street 2:APT 205
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7350
Mailing Address - Country:US
Mailing Address - Phone:479-886-2848
Mailing Address - Fax:
Practice Address - Street 1:12067 PAUL EELLS DR
Practice Address - Street 2:APT 205
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-7350
Practice Address - Country:US
Practice Address - Phone:479-886-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004431363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology