Provider Demographics
NPI:1740581222
Name:WILLIAMS, JAQUANE
Entity Type:Individual
Prefix:
First Name:JAQUANE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3802
Mailing Address - Country:US
Mailing Address - Phone:405-409-5692
Mailing Address - Fax:
Practice Address - Street 1:2125 FREMONT DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGE
Practice Address - State:OK
Practice Address - Zip Code:73120-3802
Practice Address - Country:US
Practice Address - Phone:405-409-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator