Provider Demographics
NPI:1790113595
Name:WILLIAMS-JACKSON, KAMEELA E (APN)
Entity Type:Individual
Prefix:
First Name:KAMEELA
Middle Name:E
Last Name:WILLIAMS-JACKSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:615-284-2222
Mailing Address - Fax:
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2062
Practice Address - Country:US
Practice Address - Phone:615-391-3971
Practice Address - Fax:615-232-3899
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18127363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011292Medicaid
TNQ011292Medicaid
TN103I500311Medicare PIN