Provider Demographics
NPI:1639498223
Name:WILLIAMS, KRISTEN MARIE KESSER (PA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE KESSER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6504
Mailing Address - Country:US
Mailing Address - Phone:352-351-7600
Mailing Address - Fax:352-402-5352
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-351-7600
Practice Address - Fax:352-402-5352
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002504200Medicaid
FL002504200Medicaid