Basic Information
| Provider Information | |||||||||
| NPI: | 1871548008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1118 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373341118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314388260 | ||||||||
| FaxNumber: | 9314388257 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 ELDAD RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373347005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314388260 | ||||||||
| FaxNumber: | 9314388257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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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 | 363L00000X | 67538 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.