Provider Demographics
NPI:1407825987
Name:WILLIAMS, ROBERT JUDSON (ANP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JUDSON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 N STATE ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2407
Mailing Address - Country:US
Mailing Address - Phone:601-373-7722
Mailing Address - Fax:601-373-7378
Practice Address - Street 1:7275 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-373-7722
Practice Address - Fax:601-373-7378
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR703788363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS168390702OtherUS DEPT OF LABOR
MS753068151OtherMS HEALTH PARTNERS
MSP00302039OtherRR MEDICARE - FOUND
MS00114465Medicaid
MS753068151008OtherTRICARE
MS753068151OtherMS HEALTH PARTNERS
MS$$$$$$$$$OOtherBCBS - DOGWOOD
MS$$$$$$$$$POtherBCBS - MAE
MS500028996Medicare ID - Type UnspecifiedRAIL RD MEDICARE NSG HOME
MS500001006Medicare ID - Type UnspecifiedNURSING HOME PATIENTS
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS500002067Medicare ID - Type Unspecified