Provider Demographics
NPI:1932639101
Name:WILLIAMSON, JUDD (NP-C)
Entity Type:Individual
Prefix:
First Name:JUDD
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3326
Mailing Address - Country:US
Mailing Address - Phone:936-632-6184
Mailing Address - Fax:936-632-7836
Practice Address - Street 1:1216 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3326
Practice Address - Country:US
Practice Address - Phone:936-632-6184
Practice Address - Fax:936-632-7836
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134147363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care