Provider Demographics
NPI:1497409981
Name:WILLIAMS-WALKER, SHAWUANNA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHAWUANNA
Middle Name:
Last Name:WILLIAMS-WALKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SHAWUANNA
Other - Middle Name:
Other - Last Name:WILLIAMS-LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:145 PEMBROKE CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7903
Mailing Address - Country:US
Mailing Address - Phone:601-503-0121
Mailing Address - Fax:
Practice Address - Street 1:405 BRIARWOOD DR STE 108R
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3032
Practice Address - Country:US
Practice Address - Phone:601-586-7349
Practice Address - Fax:601-586-7463
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905150363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty