Provider Demographics
NPI:1750735452
Name:WILLIAMS, CONNIE (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:ROBINSON
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1860 CHADWICK DR
Mailing Address - Street 2:SUITE 256
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:601-376-1394
Mailing Address - Fax:601-376-2005
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE 256
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-376-1394
Practice Address - Fax:601-376-2005
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901467363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care