Provider Demographics
NPI:1730520388
Name:WILLIAMS, MITZI DIGNOS (APRN-C)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:DIGNOS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:URSAL
Other - Last Name:DIGNOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-422-0409
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-422-0409
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000017585363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care