Provider Demographics
NPI:1548676992
Name:WILLIAMSON, PENNY (NP-C)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
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 1:1115 20TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-2071
Mailing Address - Country:US
Mailing Address - Phone:304-691-1900
Mailing Address - Fax:304-691-1929
Practice Address - Street 1:1115 20TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-2071
Practice Address - Country:US
Practice Address - Phone:304-691-1900
Practice Address - Fax:304-691-1929
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily