Provider Demographics
NPI:1639457534
Name:WILLIAMS, JACQUELYN (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 37TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1900
Mailing Address - Country:US
Mailing Address - Phone:515-421-4090
Mailing Address - Fax:515-421-4090
Practice Address - Street 1:1300 37TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1900
Practice Address - Country:US
Practice Address - Phone:515-421-4090
Practice Address - Fax:515-421-4090
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA00000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner