Provider Demographics
NPI:1720389570
Name:WILLIAMSON, KANEITRA L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KANEITRA
Middle Name:L
Last Name:WILLIAMSON
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 1:32845 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3977
Mailing Address - Country:US
Mailing Address - Phone:352-504-3453
Mailing Address - Fax:
Practice Address - Street 1:32845 RADIO RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3977
Practice Address - Country:US
Practice Address - Phone:352-504-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9105612363AM0700X
FLPA9105612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical