Healthcare Provider Details

I. General information

NPI: 1477819449
Provider Name (Legal Business Name): JESSICA LYNN WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 6TH ST
RENO NV
89503-4548
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 775-747-5050
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20198
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: