Individual
TISA MARIE WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3999 DUTCHMANS LN STE 7B, LOUISVILLE, KY 40207-4742
(502) 896-4791
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9425
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
4036265
KY
363LG0600X
Gerontology Nurse Practitioner
APRN.CNP.0033951
OH
Other
Enumeration date
06/07/2023
Last updated
08/26/2025
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