Provider Demographics
NPI:1588959407
Name:WILLIAMS, MARY KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4363
Mailing Address - Country:US
Mailing Address - Phone:919-322-2844
Mailing Address - Fax:919-322-2898
Practice Address - Street 1:8020 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4363
Practice Address - Country:US
Practice Address - Phone:919-322-2844
Practice Address - Fax:919-322-2898
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588959407Medicaid
NC1759NOtherBCBS
NCNCA307BMedicare PIN