Provider Demographics
NPI:1285225367
Name:WILLIAMSON, KENDRA TAYLOR (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:TAYLOR
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 N JAMAICA WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2897
Mailing Address - Country:US
Mailing Address - Phone:480-388-6135
Mailing Address - Fax:
Practice Address - Street 1:1341 N JAMAICA WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2897
Practice Address - Country:US
Practice Address - Phone:480-388-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN174361163W00000X
AZ253073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse