Provider Demographics
NPI:1487918983
Name:WILLIAMS, DANA BLALOCK (APRN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:BLALOCK
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:BLALOCK
Other - Last Name:RASBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:107 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2053
Mailing Address - Country:US
Mailing Address - Phone:318-395-2121
Mailing Address - Fax:318-395-8768
Practice Address - Street 1:107 WATTS ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2053
Practice Address - Country:US
Practice Address - Phone:318-395-2121
Practice Address - Fax:318-395-8768
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner