Provider Demographics
NPI:1962193730
Name:WILLIAMSON, ANNA LAKE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LAKE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 MAYSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9410
Mailing Address - Country:US
Mailing Address - Phone:859-498-9498
Mailing Address - Fax:
Practice Address - Street 1:7300 WOODSPOINT DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1543
Practice Address - Country:US
Practice Address - Phone:859-371-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program