Provider Demographics
NPI:1073104493
Name:WILLIAMSON, ANDREW MACKAY
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MACKAY
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23401 PRAIRIE STAR PKWY STE B-300
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-7268
Mailing Address - Country:US
Mailing Address - Phone:913-677-6319
Mailing Address - Fax:913-677-1540
Practice Address - Street 1:23401 PRAIRIE STAR PKWY STE B-300
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7268
Practice Address - Country:US
Practice Address - Phone:913-677-6319
Practice Address - Fax:913-677-1540
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2022029337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant