Provider Demographics
NPI:1366469959
Name:WILLIAMS, CATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
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 1:1404 W ULYSSES ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0509
Mailing Address - Country:US
Mailing Address - Phone:773-919-8407
Mailing Address - Fax:
Practice Address - Street 1:1818 N HIGHWAY 66 STE B
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3052
Practice Address - Country:US
Practice Address - Phone:918-379-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5170363A00000X
363A00000X
OK3081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26539Medicare PIN
P83500Medicare UPIN
ILK15630Medicare PIN