Provider Demographics
NPI:1992874762
Name:WILLIAMS, CARRIE ANN (NP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:PRZYBYCIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N CAPITOL AVE
Practice Address - Street 2:NOYES PAVILION E-140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1218
Practice Address - Country:US
Practice Address - Phone:317-962-8776
Practice Address - Fax:317-963-5285
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002222A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201094250Medicaid
INP00886816OtherRAILROAD MEDICARE
IN267030MMedicare PIN
INQ78215Medicare UPIN
INP00886816OtherRAILROAD MEDICARE
IN201094250Medicaid