Provider Demographics
NPI:1447891692
Name:WILLIAMSON, AUDREY LEANN (NP-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEANN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 STRIDER RD
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MS
Mailing Address - Zip Code:38953-9542
Mailing Address - Country:US
Mailing Address - Phone:662-417-2577
Mailing Address - Fax:
Practice Address - Street 1:401 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2257
Practice Address - Country:US
Practice Address - Phone:662-647-5816
Practice Address - Fax:662-647-5705
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner