Provider Demographics
NPI:1386050441
Name:WILLIAMSON, JOHN ROSS (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROSS
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12008 CANTLE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8028
Mailing Address - Country:US
Mailing Address - Phone:405-255-9056
Mailing Address - Fax:405-422-2521
Practice Address - Street 1:1220 N GLENN ENGLISH ST
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-2010
Practice Address - Country:US
Practice Address - Phone:580-832-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner