Provider Demographics
NPI:1073035168
Name:WILLIAMS, JERRY D II (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W VAN DORN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-2902
Mailing Address - Country:US
Mailing Address - Phone:662-274-3212
Mailing Address - Fax:662-274-3213
Practice Address - Street 1:130 W VAN DORN AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-2902
Practice Address - Country:US
Practice Address - Phone:662-274-3212
Practice Address - Fax:662-274-3213
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005207363LF0000X
MS902114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily