Healthcare Provider Details

I. General information

NPI: 1457095531
Provider Name (Legal Business Name): JESSICA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BECKS WOODS DR STE 100
BEAR DE
19701-3853
US

IV. Provider business mailing address

800 DELAWARE AVE FL 5
WILMINGTON DE
19801-1366
US

V. Phone/Fax

Practice location:
  • Phone: 302-365-8333
  • Fax: 866-334-5338
Mailing address:
  • Phone: 302-266-9166
  • Fax: 866-670-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0011159
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: