Provider Demographics
NPI:1437622909
Name:WILLIAMS, CAITLIN MAREE DEFAZIO (NP-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MAREE DEFAZIO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CALLOWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-6102
Mailing Address - Country:US
Mailing Address - Phone:662-317-9783
Mailing Address - Fax:
Practice Address - Street 1:11145 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:THAXTON
Practice Address - State:MS
Practice Address - Zip Code:38871-9024
Practice Address - Country:US
Practice Address - Phone:662-489-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily