Provider Demographics
NPI:1114575396
Name:WILLIAMS, JENNIFER MARIE (MSN, APRN, AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BASTILLE LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7149
Mailing Address - Country:US
Mailing Address - Phone:318-232-1500
Mailing Address - Fax:318-232-1501
Practice Address - Street 1:327 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-5498
Practice Address - Country:US
Practice Address - Phone:318-259-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208240363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health