Provider Demographics
NPI:1053808881
Name:WILLIAMS, MATTHEW DEAN (APRN)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S DOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKERMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72473-9064
Mailing Address - Country:US
Mailing Address - Phone:870-349-4096
Mailing Address - Fax:
Practice Address - Street 1:1205 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3533
Practice Address - Country:US
Practice Address - Phone:870-512-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily