Individual
STACY JO WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
192 BLUE RAVINE RD # 100, FOLSOM, CA 95630-4771
(916) 983-3373
Mailing address
5601 J ST, SACRAMENTO, CA 95819-3948
(916) 454-5922
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA04348
TX
363A00000X
Physician Assistant
PA19518
CA
363AS0400X
Surgical Physician Assistant
Primary
PA19518
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N8996
BLUE SHIELD
TX
01
—
P00269387
RR/MEDICARE
TX
Enumeration date
04/08/2006
Last updated
11/26/2024
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