Healthcare Provider Details

I. General information

NPI: 1306691043
Provider Name (Legal Business Name): JADE WILLIAMS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 07/18/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

IV. Provider business mailing address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: