Provider Demographics
NPI:1730592502
Name:WILLIAMS, JASMIN (CD DONA)
Entity type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CD DONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828B WALTERS CIR
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-5012
Mailing Address - Country:US
Mailing Address - Phone:774-437-9039
Mailing Address - Fax:
Practice Address - Street 1:4828B WALTERS CIR
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-5012
Practice Address - Country:US
Practice Address - Phone:774-437-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist