Provider Demographics
NPI:1073550273
Name:WILLIAMS, MARIE JAQUELINE (NP)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:JAQUELINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:STE 605
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1650
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-326-1501
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-326-1501
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR830287363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500017613OtherRAILROAD MEDICARE
MS0123514Medicaid
P01112718OtherMEDICARE RAILROAD
MS500017613OtherRAILROAD MEDICARE
MS0123514Medicaid