DR. JERRY D WILLIAMS II (NPI# 1073035168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073035168 |
| Entity Type | Individual |
| Full Name | DR. JERRY D WILLIAMS II |
| Credential | FNP-C |
| Practice Address |
340 Stateline Rd W Southaven MS 38671 |
| Mailing Address |
130 W Van Dorn Ave Holly Springs MS 38635-2902 |
| Practice Telephone | 6625793955 |
| Mailing Telephone | 6622743212 |
| Mailing Fax Number | 6622743213 |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2020-03-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
902114 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
A005207 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 340 Stateline Rd W, Southaven, MS 386711610 | 6625793955 | |
| 812b Newman Dr, Helena, AR 72342 | 8703388312 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881164762 | Jerry B Williams | Dentist | 24121 Ne 124th Circle, Brush Prairie, WA 98606-4322 | 2018-12-04 |
| 1447317722 | Jerry Valentine Williams | Internal Medicine | 317 W Ascension St, Gonzales, LA 70737-2805 | 2007-01-03 |
| 1962516195 | Jerry Lee Williams | Dentist | 310 N Tennessee St, Suite E, Cartersville, GA 30120-3270 | 2006-08-17 |
| 1053308114 | Jerry W Williams | Optometrist | 1605 W Court St, Winnfield, LA 71483-2653 | 2005-10-04 |
| 1538618145 | Jerry Williams | Nurse Practitioner | 1340 Broad Ave Ste 300, Gulfport, MS 39501-2404 | 2016-09-23 |
| 1326398249 | Jerry Williams | Counselor | 1302 Calle De La Merced, Espanola, NM 87532-2624 | 2012-09-18 |
| 1184877698 | Jerry Roy Williams | Counselor | 1255 Hilyard St, Eugene, OR 97401-3718 | 2008-10-28 |
| 1174791727 | Jerry Gregory Williams | Counselor | 2814 Lancaster Ave, Wilmington, DE 19805-5225 | 2008-02-18 |
| 1902028087 | Jerry Lee Williams | Counselor | 4041 Marlton Ave, Suite 136, Los Angeles, CA 90008-2519 | 2007-05-02 |
| 1710086749 | Jerry K Williams Jr. | Psychiatry & Neurology | 2301 7th St, Suite B, Las Vegas, NM 87701-4966 | 2006-09-22 |
| Street Address |
340 STATELINE RD W |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700088085 | Kallol Kumar Saha | Family Medicine | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2007-05-31 |
| 1851916837 | Amanda Folsom | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-06-15 |
| 1659990075 | Addiction Campuses Professional Services of Mississippi, LLC | Psychiatry & Neurology | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-04-15 |
| 1831728583 | Treneise Hunt-smith | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-04-05 |
| 1164083747 | Jennifer Gail Ross | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2019-06-25 |
| 1356703524 | Addiction Campuses of Mississippi, LLC | Substance Abuse Rehabilitation Facility | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2016-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615616 | Jack Chandler Papa | Nurse Practitioner | 3556 May Brook Cv, Southaven, MS 38672-1006 | 2020-09-26 |
| 1518583129 | Susan E Mccullough | Nurse Practitioner | 5932 Antler Trl, Southaven, MS 38672-6511 | 2020-06-19 |
| 1336764778 | Raquel Janay Reed-washington | Nurse Practitioner | 3548 Herbert Cv, Southaven, MS 38672-2003 | 2020-06-11 |
| 1104452887 | Vincent Lee Spinosa-parker | Nurse Practitioner | 5056 Maiden Lane Cv, Southaven, MS 38672-6000 | 2020-03-13 |
| 1215438437 | Alba Laura Emerson | Nurse Practitioner | 1862 Lindsey Ln, Southaven, MS 38672-8602 | 2018-02-22 |
| 1629583026 | Lachasity Kimmons | Nurse Practitioner | 2032 Audubon Pl, Southaven, MS 38672-9440 | 2017-12-06 |
| 1124322474 | Ageless Men's Health, LLC | Nurse Practitioner | 7111 Southcrest Pkwy, Suite 109, Southaven, MS 38671-4850 | 2010-12-30 |
| 1487757365 | Regina G Seaton | Nurse Practitioner | 7676 Airways Blvd, Southaven, MS 38671-5304 | 2006-09-06 |
| 1063465482 | Misty Ann Moore | Nurse Practitioner | 7585 Clarington Cove, Southaven, MS 38671-2300 | 2006-05-18 |
| 1184602450 | Tammy Louise Carnahan | Nurse Practitioner | 7900 Airways Blvd, Building A Suite 6, Southaven, MS 38671-4113 | 2006-01-05 |
| Find all providers in SOUTHAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.