Individual
JESSICA WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
68628
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093211732
NPI LPN
OK
Enumeration date
04/02/2018
Last updated
06/24/2020
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