Provider Demographics
NPI:1578458907
Name:WILLIAMS, SCOTT JOSEPH (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10947 COSMOS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4914
Mailing Address - Country:US
Mailing Address - Phone:314-662-3495
Mailing Address - Fax:
Practice Address - Street 1:1231 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2527
Practice Address - Country:US
Practice Address - Phone:314-662-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025013208363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health