Basic Information
| Provider Information | |||||||||
| NPI: | 1811000540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 HIAWATHA TRL | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713604405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186403262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2495 SHREVEPORT HWY 71 NORTH | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | 3184835036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | AP02638 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.