Provider Demographics
NPI:1225527773
Name:WILLIAMSON, MCKENNA ALEXIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MCKENNA
Middle Name:ALEXIS
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MCKENNA
Other - Middle Name:ALEXIS
Other - Last Name:RUBALCABA-WILLIAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4315 JAMES CASEY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3364
Mailing Address - Country:US
Mailing Address - Phone:512-383-9752
Mailing Address - Fax:512-406-7336
Practice Address - Street 1:4315 JAMES CASEY ST STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3364
Practice Address - Country:US
Practice Address - Phone:512-383-9752
Practice Address - Fax:512-406-7336
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT6413OtherPHYSICIAN MEDICAL LICENSE
TXFW1466879OtherDEA REGISTRATION NUMBER