Healthcare Provider Details

I. General information

NPI: 1558833129
Provider Name (Legal Business Name): JENNIFER LYNN WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN JACQUES

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N MO PAC EXPY STE 200
AUSTIN TX
78731-3282
US

IV. Provider business mailing address

110 DEER RIDGE DR
ROUND ROCK TX
78681-5514
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-458-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP138321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: