Provider Demographics
NPI:1477998326
Name:WILLIAMS, JESSICA I (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:I
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 1:10710 CHARTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3276
Mailing Address - Country:US
Mailing Address - Phone:443-276-9000
Mailing Address - Fax:443-276-9610
Practice Address - Street 1:10710 CHARTER DR STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:443-276-9000
Practice Address - Fax:443-276-9610
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR235631363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health