Provider Demographics
NPI:1891337796
Name:WILLIAMS, KELSEY LOUISE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LOUISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S HARVARD AVE APT J
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3563
Mailing Address - Country:US
Mailing Address - Phone:918-919-2896
Mailing Address - Fax:
Practice Address - Street 1:12455 E 100TH ST N STE 350
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4675
Practice Address - Country:US
Practice Address - Phone:918-274-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant