Provider Demographics
NPI:1538982962
Name:WILLIAMS, MARY KATHERINE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20783 INTERSTATE 20 S ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-3573
Mailing Address - Country:US
Mailing Address - Phone:903-567-5437
Mailing Address - Fax:
Practice Address - Street 1:20783 INTERSTATE 20 S ACCESS RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3573
Practice Address - Country:US
Practice Address - Phone:903-567-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179457363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care