Provider Demographics
NPI:1447650726
Name:WILLIAMSON, BRIDGET (PA-C)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8282 MOREL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-8106
Mailing Address - Country:US
Mailing Address - Phone:317-490-1791
Mailing Address - Fax:888-981-1831
Practice Address - Street 1:8282 MOREL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-8106
Practice Address - Country:US
Practice Address - Phone:317-490-1791
Practice Address - Fax:888-981-1831
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001720A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266180411Medicare PIN