Provider Demographics
NPI:1972357911
Name:WILLIAMS, JESSICA SUE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DAUGHERTY CIR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5276
Mailing Address - Country:US
Mailing Address - Phone:740-899-0307
Mailing Address - Fax:
Practice Address - Street 1:2596 1/2 GRATIOT RD SE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43056-9314
Practice Address - Country:US
Practice Address - Phone:740-763-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide