Develle Williams, APRN MSN FNP BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

23232 Issued in CA

Practice address

16177 Hesperian Blvd Ste C
San Lorenzo, CA 94580-2451

Phone

(510) 276-5558

Fax

(510) 276-5646

NPI assigned

May 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

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.

• Midlands Cardiology Associates

  • Cardiovascular Disease Physician
  • Columbia, SC
  • NPI 1164534327
  NPD (past)

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1871709378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 BEDFORD CT",
            "city": "COLUMBIA",
            "state": "CA",
            "postal_code": "292235536",
            "telephone_number": "803-309-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16177 HESPERIAN BLVD STE C",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802451",
            "telephone_number": "510-276-5558",
            "fax_number": "510-276-5646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Main St",
            "address_2": "suite 102",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292035800",
            "country_code": "US",
            "telephone_number": "803-333-0456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DEVELLE",
        "name_prefix": "Ms.",
        "credential": "APRN MSN FNP BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "1516",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "23232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE  LICENSE APRN 1516",
            "identifier": "1516",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP CERTIFICATE",
            "identifier": "23232",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AACN",
            "identifier": "10574146",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in San Lorenzo, CA
• Providers in San Lorenzo, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.