Provider Demographics
NPI:1992764518
Name:WILLIAMS, CHRYSTI LYN (MD)
Entity type:Individual
Prefix:
First Name:CHRYSTI
Middle Name:LYN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 W CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3349
Mailing Address - Country:US
Mailing Address - Phone:501-778-8264
Mailing Address - Fax:501-778-7360
Practice Address - Street 1:819 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3349
Practice Address - Country:US
Practice Address - Phone:501-778-8264
Practice Address - Fax:501-778-7360
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128527001Medicaid
418028OtherHEALTHLINK
0120294OtherUNITED HEALTHCARE
AR5690534OtherAETNA
AR175310000OtherQUALCHOICE
5J920OtherBCBS
AR080099539Medicare PIN
0120294OtherUNITED HEALTHCARE
5J920OtherBCBS
AR5J920Medicare PIN