Provider Demographics
NPI:1770041691
Name:WILLIAMS, GENOVA L (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:GENOVA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 WOODRUFF ST
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:AR
Practice Address - Zip Code:71826-8715
Practice Address - Country:US
Practice Address - Phone:870-330-6060
Practice Address - Fax:501-468-0497
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11170086OtherAANP FNP CERTIFICATION NUMBER
TX803397OtherRN LICENSE NUMBER
TXAP136038OtherAPRN LICENSE NUMBER