Healthcare Provider Details

I. General information

NPI: 1619461175
Provider Name (Legal Business Name): JESSICA RENAE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S FRENCH BROAD AVE
ASHEVILLE NC
28801-4364
US

IV. Provider business mailing address

390 S FRENCH BROAD AVE
ASHEVILLE NC
28801-4364
US

V. Phone/Fax

Practice location:
  • Phone: 828-378-0075
  • Fax: 828-378-0083
Mailing address:
  • Phone: 828-378-0075
  • Fax: 828-378-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number303799
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number690
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: