Provider Demographics
NPI:1063919413
Name:WILLIAMS, ANDRE'LYN T (PA-C)
Entity type:Individual
Prefix:
First Name:ANDRE'LYN
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21022 CREEK EDGE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4065
Mailing Address - Country:US
Mailing Address - Phone:832-713-1926
Mailing Address - Fax:
Practice Address - Street 1:21022 CREEK EDGE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4065
Practice Address - Country:US
Practice Address - Phone:832-713-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant