Active NPI
Carlene Annmarie Williams-Jack
- Registered Nurse
- Mount Vernon, NY
National Provider Identifier
1306638960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 96459901
- Practice address
- 324 E 4TH St Apt C10
Mount Vernon, NY 10553-1524 - Phone
- (347) 579-6654
- NPI assigned
- May 20, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 96459901 | NY | Primary |
Addresses
Primary practice location
324 E 4TH St Apt C10
Mount Vernon, NY 10553-1524
Mailing address
324 E 4TH St Apt C10
Mount Vernon, NY 10553-1524
Phone (347) 579-6654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96459901 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747699200000",
"number": "1306638960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 E 4TH ST APT C10",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105531524",
"telephone_number": "347-579-6654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 E 4TH ST APT C10",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "105531524",
"telephone_number": "347-579-6654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS-JACK",
"first_name": "CARLENE",
"middle_name": "ANNMARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-20",
"last_updated": "2025-05-20",
"certification_date": "2025-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "96459901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.