Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | APN0000005141 | TN |
NPI | 1487707600 |
---|---|
Provider Name | Ms. Jennifer Jane Williams |
First Address | Blountville, TN 37617-0630 |
Second Address | Blountville, TN 37617-0630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |