Provider Demographics
NPI:1427317585
Name:WILLIAMS, JESSICA WHICKER (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WHICKER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E HARMONY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8623
Mailing Address - Country:US
Mailing Address - Phone:970-495-7000
Mailing Address - Fax:
Practice Address - Street 1:2315 E HARMONY RD STE 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8623
Practice Address - Country:US
Practice Address - Phone:970-495-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1406872084N0400X
WY14066A2084N0400X
390200000X
CODR.00585782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149246Medicaid
WY216015300Medicaid