Provider Demographics
NPI:1548242779
Name:WILLIAMS, JODY L (CRNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 202,502
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-861-0377
Mailing Address - Fax:610-861-7358
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 202,502
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-861-0377
Practice Address - Fax:610-861-7358
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA094908F42Medicare ID - Type Unspecified