Individual provider Active NPI

Christa Jean Williams, FNP-BC

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1639919699
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
268982 Issued in AZ
Practice address
19646 N 27TH Ave Ste 305
Phoenix, AZ 85027-4027
Phone
(480) 556-0446
NPI assigned
May 28, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 268982 AZ Primary

Addresses

Primary practice location

19646 N 27TH Ave Ste 305
Phoenix, AZ 85027-4027

Mailing address

5645 W Rainwater Dr
Laveen, AZ 85339-5705
Phone (702) 726-1904

Other names 1

  • Christa Jean Dodgen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240717003696 AZ Practitioner - Nurse Practitioner 0143765818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richard Lee Averitte Jr PLLCGroup PAC ID 9638069099, 31 clinicians

Practice addresses (Care Compare)

19646 N 27TH Ave
Suite 305
Phoenix, AZ 85027-4027
Phone (480) 556-0446

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Lee Averitte Jr PLLC CurrentSince Aug 5, 2024 Accepting new patients
Richard Lee Averitte Jr PLLC PastSince Jun 2, 2024 Accepting new patients

Locations

19646 N 27th Ave
Ste 305
Phoenix, AZ 85027

20401 N 73rd St
Ste 230
Scottsdale, AZ 85255

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1639919699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5645 W RAINWATER DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853395705",
            "telephone_number": "702-726-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19646 N 27TH AVE STE 305",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274027",
            "telephone_number": "480-556-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CHRISTA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "268982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTA",
            "last_name": "DODGEN",
            "middle_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.