Organization
TRI-COUNTY COMMUNITY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LADONNA JEAN WILLIAMS DNP, PMHNP-BC, FNP-C (OWNER)
(573) 521-8530
Entity
Organization
Contact information
Practice address
46 E STATE HIGHWAY 162, PORTAGEVILLE, MO 63873-9177
(573) 379-8031
(573) 391-8050
Mailing address
46 E STATE HIGHWAY 162, PORTAGEVILLE, MO 63873-9177
(573) 391-8031
(573) 391-8050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861826968
—
MO
Enumeration date
01/26/2020
Last updated
06/09/2022
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