Provider Demographics
NPI:1447324272
Name:WILLIAMS, GWENDOLYN (CFNP)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CATCHINGS AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2468
Mailing Address - Country:US
Mailing Address - Phone:662-887-2494
Mailing Address - Fax:662-887-3208
Practice Address - Street 1:401 CATCHINGS AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2468
Practice Address - Country:US
Practice Address - Phone:662-887-2494
Practice Address - Fax:662-887-3208
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349327363L00000X
MSR745811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124148Medicaid
MS00124148Medicaid