Provider Demographics
NPI:1699848176
Name:WILLIAMS, JILL S (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HAMAKUA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3984
Mailing Address - Country:US
Mailing Address - Phone:808-432-3400
Mailing Address - Fax:
Practice Address - Street 1:201 HAMAKUA DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3984
Practice Address - Country:US
Practice Address - Phone:808-432-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55066701Medicaid
HI55066701Medicaid
HIS38680Medicare UPIN