Provider Demographics
NPI:1194380188
Name:WILLIAMS, MICHELLE LOVE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOVE
Last Name:WILLIAMS
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 1:18915 MEISNER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4223
Mailing Address - Country:US
Mailing Address - Phone:210-499-5158
Mailing Address - Fax:210-678-3730
Practice Address - Street 1:18915 MEISNER DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4223
Practice Address - Country:US
Practice Address - Phone:210-499-5158
Practice Address - Fax:210-678-3730
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113791363A00000X
TXPA16996363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant