Provider Demographics
NPI:1124793625
Name:WILLIAMSON, KERRY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHWELL HEALTH PHYSICIAN PARTNER OB GYN
Mailing Address - Street 2:370 EAST MAIN STREET
Mailing Address - City:BAYSHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-224-4200
Mailing Address - Fax:
Practice Address - Street 1:370 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8415
Practice Address - Country:US
Practice Address - Phone:631-224-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily