Provider Demographics
NPI:1831719384
Name:WILLIAMS, JILLIAN R B (FNP-BC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:R B
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:R B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3721 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3405
Mailing Address - Country:US
Mailing Address - Phone:314-328-0144
Mailing Address - Fax:314-788-3021
Practice Address - Street 1:3721 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3405
Practice Address - Country:US
Practice Address - Phone:314-328-0144
Practice Address - Fax:314-788-3021
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23838363LF0000X
MO2024044282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6949Medicaid