Individual
REGINA A WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
200 HOSPITAL DR, TYLERTOWN, MS 39667-2020
(601) 876-5303
(601) 876-0653
Mailing address
PO BOX 677, TYLERTOWN, MS 39667-0677
(601) 876-5303
(601) 876-0653
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R567396
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02154265
—
MS
01
—
1700416057
GEHA
MS
01
—
4563153
AETNA
MS
05
—
891011540
—
AL
01
—
939084
WINDSOR
MS
01
—
P01087216
RAILROAD MEDICARE
MS
Enumeration date
08/16/2006
Last updated
06/20/2013
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