Basic Information
Provider Information
NPI: 1003007279
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: JENNIFER
MiddleName: CHRISTI
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 190
Address2:  
City: TOPPENISH
State: WA
PostalCode: 989480190
CountryCode: US
TelephoneNumber: 5092483334
FaxNumber:  
Practice Location
Address1: 602 E NOB HILL BLVD
Address2:  
City: YAKIMA
State: WA
PostalCode: 989013534
CountryCode: US
TelephoneNumber: 5092483334
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 04/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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