Healthcare Provider Details

I. General information

NPI: 1124789508
Provider Name (Legal Business Name): JENNIFER WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S FRONTAGE RD
VICKSBURG MS
39180-5328
US

IV. Provider business mailing address

1262 KIMBELL RD
TERRY MS
39170-9438
US

V. Phone/Fax

Practice location:
  • Phone: 601-654-7070
  • Fax:
Mailing address:
  • Phone: 601-218-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905092
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: