Provider Demographics
NPI:1164502100
Name:WILLIAMS, NICOLE DIANE (RD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 TIMBERLINE LN
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6029
Mailing Address - Country:US
Mailing Address - Phone:903-892-1632
Mailing Address - Fax:903-892-1632
Practice Address - Street 1:1605 TIMBERLINE LN
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6029
Practice Address - Country:US
Practice Address - Phone:903-892-1632
Practice Address - Fax:903-892-1632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6223Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY