Provider Demographics
NPI:1386623015
Name:WILLIAMS, MICHAEL N (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-285-9006
Mailing Address - Fax:606-218-4562
Practice Address - Street 1:263 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-218-3500
Practice Address - Fax:606-218-4562
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002986Medicaid
KY3331033Medicare PIN
P38864Medicare UPIN
KY95002986Medicaid
KY0549007Medicare PIN
KY183437Medicare PIN
KY183441Medicare PIN
KY5491Medicare PIN
KY0549103Medicare PIN
KY5490Medicare PIN
KY183442Medicare PIN