Provider Demographics
NPI:1932819778
Name:WILLIAMSON, ALICIA KAY (MSN, PMHNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAY
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSN, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8539
Mailing Address - Country:US
Mailing Address - Phone:989-464-0714
Mailing Address - Fax:
Practice Address - Street 1:118 W MAIN ST STE C2
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1378
Practice Address - Country:US
Practice Address - Phone:989-370-9157
Practice Address - Fax:989-448-2421
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284908163WP0807X, 163WP0808X, 363LP0808X
MI4704284908NSA2210P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health