Healthcare Provider Details

I. General information

NPI: 1568016806
Provider Name (Legal Business Name): JESSICA MARIE WILLIAMS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA WILLERS

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

3301 MAPLE ST N
FARGO ND
58102-1230
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax:
Mailing address:
  • Phone: 507-227-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR38762
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: