Provider Demographics
NPI:1447291778
Name:WILLIAMS, LOLA KATHLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:KATHLEEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LOLA
Other - Middle Name:KATHLEEN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:1220 MAIN DRIVE
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2400
Mailing Address - Country:US
Mailing Address - Phone:205-349-3250
Mailing Address - Fax:205-345-3993
Practice Address - Street 1:10290 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKMAN
Practice Address - State:AL
Practice Address - Zip Code:35579-5845
Practice Address - Country:US
Practice Address - Phone:205-622-2830
Practice Address - Fax:205-622-2673
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1051448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL109150Medicaid
AL102I503424Medicare PIN