Provider Demographics
NPI:1013625326
Name:WILLIAMS BELLE, JESSYKA JENIECE
Entity type:Individual
Prefix:
First Name:JESSYKA
Middle Name:JENIECE
Last Name:WILLIAMS BELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-2334
Mailing Address - Country:US
Mailing Address - Phone:662-574-6652
Mailing Address - Fax:
Practice Address - Street 1:720 N LEHMBERG RD STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-4312
Practice Address - Country:US
Practice Address - Phone:800-817-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS246RP1900X
MS25D2270447247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05Medicaid