Provider Demographics
NPI:1134594187
Name:WILLIAMS, JAMISON (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 HAVENHURST DR APT 104
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4938
Mailing Address - Country:US
Mailing Address - Phone:731-608-7498
Mailing Address - Fax:
Practice Address - Street 1:8000 SUNSET BLVD STE B200, #41
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-9004
Practice Address - Country:US
Practice Address - Phone:731-608-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18270363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care