Healthcare Provider Details

I. General information

NPI: 1073866489
Provider Name (Legal Business Name): JENA WILLIAMS HAMM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENA MARIE WILLIAMS

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 HIGHWAY 43 STE 10
RUSSELLVILLE AL
35653-4558
US

IV. Provider business mailing address

13150 HIGHWAY 43 STE 10
RUSSELLVILLE AL
35653-4558
US

V. Phone/Fax

Practice location:
  • Phone: 256-331-2092
  • Fax: 256-331-2096
Mailing address:
  • Phone: 256-331-2092
  • Fax: 256-331-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-069726
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: