Provider Demographics
NPI:1659815603
Name:WILLIAMS, JACQUELINE RENEE (FNP-C, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 BELLI DR APT 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2370
Mailing Address - Country:US
Mailing Address - Phone:786-325-0594
Mailing Address - Fax:
Practice Address - Street 1:765 BELLI DR APT 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2370
Practice Address - Country:US
Practice Address - Phone:786-325-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1116256363LF0000X
NVAPRN822878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily