Provider Demographics
NPI:1649533944
Name:WILLIAMS, JESSICA DANIELLE (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DANIELLE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5700 E INTERSTATE 20 SERVICE RD S
Mailing Address - Street 2:STE 100
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76008-5115
Mailing Address - Country:US
Mailing Address - Phone:817-489-7300
Mailing Address - Fax:817-489-7302
Practice Address - Street 1:5700 E INTERSTATE 20 SERVICE RD S
Practice Address - Street 2:STE 100
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76008-5115
Practice Address - Country:US
Practice Address - Phone:817-489-7300
Practice Address - Fax:817-489-7302
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine