Basic Information
| Provider Information | |||||||||
| NPI: | 1457357063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | KATHLENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | C.F.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HODGES | ||||||||
| OtherFirstName: | KATHLENE | ||||||||
| OtherMiddleName: | SUZANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | C.F.N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 24023 | ||||||||
| Address2: | DEPT #03-054 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392254023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018993989 | ||||||||
| FaxNumber: | 6018993504 | ||||||||
| Practice Location | |||||||||
| Address1: | 5903 RIDGEWOOD ROAD | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392113702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018993989 | ||||||||
| FaxNumber: | 6018993504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN13944 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R530719 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.