Provider Demographics
NPI:1962877852
Name:WILLIAMS, RENEE DENISE (APRN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCY WAY
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3000
Mailing Address - Country:US
Mailing Address - Phone:479-802-5555
Mailing Address - Fax:479-876-2829
Practice Address - Street 1:1 MERCY WAY
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3000
Practice Address - Country:US
Practice Address - Phone:479-802-5555
Practice Address - Fax:479-876-2829
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004668363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner