Provider Demographics
NPI:1790655355
Name:WILLIAMS, RICHEY C
Entity type:Individual
Prefix:
First Name:RICHEY
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-8042
Mailing Address - Country:US
Mailing Address - Phone:479-800-3470
Mailing Address - Fax:
Practice Address - Street 1:2408 S 51ST CT STE G
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3666
Practice Address - Country:US
Practice Address - Phone:479-800-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program