Provider Demographics
NPI:1407934664
Name:WILLIAMSON, KELLY DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5644
Mailing Address - Country:US
Mailing Address - Phone:325-692-9613
Mailing Address - Fax:
Practice Address - Street 1:1857 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2429
Practice Address - Country:US
Practice Address - Phone:325-670-4545
Practice Address - Fax:325-670-2896
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143925Medicaid
TX4588060OtherNABP NUMBER
TX4588060OtherNABP NUMBER