Provider Demographics
NPI:1164497509
Name:WILLIAMS, DEBBIE L (PA)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5899
Practice Address - Country:US
Practice Address - Phone:214-947-2874
Practice Address - Fax:214-947-2884
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12233363A00000X
TNPA2311363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531481Medicaid
4348378OtherBCBS
TN103I978033Medicare PIN
TN1531481Medicaid
TXTXB103894Medicare PIN
TX200857504Medicaid
TX200857506Medicaid
TXTXB103895Medicare PIN
LA1590169Medicaid