Provider Demographics
NPI:1144297755
Name:WILLIAMS, LUELLA A (CFNP)
Entity type:Individual
Prefix:
First Name:LUELLA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-0475
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-374-2713
Practice Address - Street 1:15024 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-8306
Practice Address - Country:US
Practice Address - Phone:228-864-0003
Practice Address - Fax:228-864-0273
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR628301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114438Medicaid
MS500000421Medicare PIN
S70984Medicare UPIN