Provider Demographics
NPI:1528023694
Name:WILLIAMSON, KRISTIN M (RPA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:116 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4118
Mailing Address - Country:US
Mailing Address - Phone:716-908-6417
Mailing Address - Fax:716-631-9525
Practice Address - Street 1:400 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5760
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:716-631-9525
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009406-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6747Medicare ID - Type Unspecified