Provider Demographics
NPI:1114654035
Name:WILLIAMSON, KATIE LORRAINE (FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LORRAINE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 NORTH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1434
Mailing Address - Country:US
Mailing Address - Phone:409-767-8184
Mailing Address - Fax:
Practice Address - Street 1:3030 NORTH ST STE 310
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1434
Practice Address - Country:US
Practice Address - Phone:409-767-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily