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General NPI Number Information
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NPI Number | 1629031984
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Entity Type | Individual
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Provider Name | STACY JO WILLIAMS PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 192 BLUE RAVINE RD # 100
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City | FOLSOM
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State | CA
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Zip | 95630-4771
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Country | US
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Telephone | 916-983-3373
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3948
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Country | US
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Telephone | 916-454-5922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04348
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19518
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA19518
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License Number State | CA
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