Jacqueline M Williams, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT-106 Issued in ID

Practice address

University of Idaho
Dept. of Hperd Peb 100
Moscow, ID 83844-2401

Phone

(208) 885-2185

Fax

(208) 885-5929

NPI assigned

Aug 12, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Behavioral Health Solutions P a

  • Counselor
  • Moscow, ID
  • NPI 1497965578
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992717805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 VANDAL DR",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439229",
            "telephone_number": "208-882-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF IDAHO",
            "address_2": "DEPT. OF HPERD PEB 100",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838442401",
            "telephone_number": "208-885-2185",
            "fax_number": "208-885-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Annetta Wilson, P.T.
• Kylie Elizabeth Wilson
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• Lila M Witter, LMT

• Athletic Trainer in Moscow, ID
• Providers in Moscow, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.