Provider Demographics
NPI:1659835072
Name:WILLIAMS, KRISTEN NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:NICOLE
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 1:1000 TAVERN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2853
Mailing Address - Country:US
Mailing Address - Phone:304-263-6165
Mailing Address - Fax:304-263-6536
Practice Address - Street 1:1839 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-773-2689
Practice Address - Fax:304-263-6536
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2355363AM0700X
390200000X
VA0110007062363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program