MEDICARE: CHRISTINA JACKSON WILLIAMS WHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	0024180460	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	276885	OTHER	NC	NC BON

General Provider Information

NPI Number	:	1417593120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA JACKSON WILLIAMS WHNP-BC

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD STE A
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-316-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 DENBIGH BLVD STE B
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-6501
Country	:	US
Telephone Number	:	757-750-2400
Fax Number	:	757-243-8382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	05/09/2024

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