Provider Demographics
NPI:1265401038
Name:WILLIAMS, MICHELLE E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:ERWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1401 HARRODSBURG RD STE A110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3778
Practice Address - Country:US
Practice Address - Phone:859-258-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA929363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005724Medicaid
VA10207029Medicaid
VA10207029Medicaid
KYC60181OtherCHI
KY000000381759OtherBLUE CROSS BLUE SHIELD
KY95005724Medicaid
11487090OtherCAQH
611274508OtherTAX ID NUMBER
KY00637023Medicare PIN
KY000000381759OtherBLUE CROSS BLUE SHIELD