Provider Demographics
NPI:1366156333
Name:WILLIAMS, JESSICA DAWN (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, PMHNP
Mailing Address - Street 1:130 A ST SW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6806
Mailing Address - Country:US
Mailing Address - Phone:918-533-1836
Mailing Address - Fax:
Practice Address - Street 1:130 A ST SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6806
Practice Address - Country:US
Practice Address - Phone:918-533-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211293363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health