Provider Demographics
NPI:1053424093
Name:WILLIAMS, REGINA A (CNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-0677
Mailing Address - Country:US
Mailing Address - Phone:601-876-5303
Mailing Address - Fax:601-876-0653
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2020
Practice Address - Country:US
Practice Address - Phone:601-876-5303
Practice Address - Fax:601-876-0653
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR567396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01087216OtherRAILROAD MEDICARE
MS02154265Medicaid
MS939084OtherWINDSOR
MS4563153OtherAETNA
MS1700416057OtherGEHA
AL891011540Medicaid
MS939084OtherWINDSOR
MS1700416057OtherGEHA