Provider Demographics
NPI:1730235367
Name:WILLIAMS, CAROL L (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:505 SOUTH NOLAN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:512-522-3982
Mailing Address - Fax:
Practice Address - Street 1:801 E WHITESTONE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7423
Practice Address - Country:US
Practice Address - Phone:512-528-2000
Practice Address - Fax:512-528-2020
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192437501Medicaid
TX8K2601Medicare PIN