Basic Information
| Provider Information | |||||||||
| NPI: | 1295324861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | EVANS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 VIRGINIA RD # 629 | ||||||||
| Address2: | |||||||||
| City: | EDENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279329668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524828451 | ||||||||
| FaxNumber: | 2524826435 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 VIRGINIA RD | ||||||||
| Address2: | |||||||||
| City: | EDENTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279329668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524828451 | ||||||||
| FaxNumber: | 2524826435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2021 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 172112 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.