Randall Blake Williams

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP144567 Issued in TX

Practice address

3111 McCann Rd
Longview, TX 75605-7842

Phone

(903) 753-1212

NPI assigned

Jan 14, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Acute Care Specialists

  • Emergency Medicine Physician
  • Longview, TX
  • NPI 1740655273

  Single Specialty

  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  Single Specialty

  Medicare reassignment NPD
• BWBL Group

  • Primary Care Clinic/Center
  • Tyler, TX
  • NPI 1093581597
  NPD Authorized official
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1194365585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22732 INTERSTATE 20 E",
            "city": "WINONA",
            "state": "TX",
            "postal_code": "757926906",
            "telephone_number": "903-539-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 MCCANN RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057842",
            "telephone_number": "903-753-1212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3943 Old Jacksonville Rd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757018519",
            "country_code": "US",
            "telephone_number": "903-593-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RANDALL",
        "middle_name": "BLAKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP144567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathy Ann Pippins Williams
• Mark Johnston Williams, M.D.
• Matthew Joshua Williams, CRNA
• Nina B Williams, LPC
• Paul Brian Williams, M.D.
• Ricky Anthony Williams, R.PH.
• Tiffany Williams
• Eric D Willie
• Kimberly Parrott Willingham
• Kyle Alan Willingham, M.D.

• Family Nurse Practitioner in Longview, TX
• Providers in Longview, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.