Individual
RAVEN SHANISE WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
702 W. M.L.K. JR DR., MOUND BAYOU, MS 38762
(662) 741-2151
Mailing address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 741-8800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
6260
TN
363A00000X
Physician Assistant
8040
AZ
363A00000X
Physician Assistant
Primary
PA00656
MS
Other
Enumeration date
05/18/2019
Last updated
05/20/2025
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