MEDICARE: JESSICA DANIELLE WILLIAMS DO

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	207Q00000X	Family Medicine Physician	BP10044700	TX

General Provider Information

NPI Number	:	1649533944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DANIELLE WILLIAMS DO

Provider Business Mailing Address
First Line	:	5700 E INTERSTATE 20 SERVICE RD S
Second Line	:	STE 100
City	:	WILLOW PARK
State	:	TX
Zip	:	76008-5115
Country	:	US
Telephone Number	:	817-489-7300
Fax Number	:	817-489-7302

Provider Business Practice Location Address
First Line	:	5700 E INTERSTATE 20 SERVICE RD S
Second Line	:	STE 100
City	:	WILLOW PARK
State	:	TX
Zip	:	76008-5115
Country	:	US
Telephone Number	:	817-489-7300
Fax Number	:	817-489-7302

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

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	02/11/2022

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