Healthcare Provider Details

I. General information

NPI: 1609967538
Provider Name (Legal Business Name): JESSICA GARDNER WILLIAMS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/21/2022
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 N SCOTTSDALE RD SUITE 202
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

18511 N SCOTTSDALE RD SUITE 202
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7242
  • Fax: 480-306-6246
Mailing address:
  • Phone: 480-306-7242
  • Fax: 480-306-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1988
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: