Basic Information
| Provider Information | |||||||||
| NPI: | 1073104493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MACKAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104TH ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641314517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169322700 | ||||||||
| FaxNumber: | 8169322705 | ||||||||
| Practice Location | |||||||||
| Address1: | 4320 WORNALL RD STE 710 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169322700 | ||||||||
| FaxNumber: | 8169322705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2022029337 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.