Provider Demographics
NPI:1871858464
Name:LITTLE, CELICIA WILLIAMS (CRNP)
Entity type:Individual
Prefix:
First Name:CELICIA
Middle Name:WILLIAMS
Last Name:LITTLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744787
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4787
Mailing Address - Country:US
Mailing Address - Phone:301-572-8734
Mailing Address - Fax:301-681-0789
Practice Address - Street 1:9015 WOODYARD RD STE 111
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4226
Practice Address - Country:US
Practice Address - Phone:301-599-0900
Practice Address - Fax:301-599-7828
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9267954163W00000X
MDR216132363LP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse