Healthcare Provider Details

I. General information

NPI: 1003122318
Provider Name (Legal Business Name): JENNIFER GALLAGHER WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST STE 1S
MOBILE AL
36604-1512
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-5437
  • Fax: 251-434-3852
Mailing address:
  • Phone: 251-410-5437
  • Fax: 251-434-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-106613
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: