Provider Demographics
NPI:1962520130
Name:WILLIAMSON, KERRY ANN (RN, APRN)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6813
Mailing Address - Country:US
Mailing Address - Phone:860-533-1148
Mailing Address - Fax:860-646-9680
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:WATKINS CENTER, SUITE C2
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6059
Practice Address - Country:US
Practice Address - Phone:860-646-2525
Practice Address - Fax:860-646-9680
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000890363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004199205Medicaid
CT400000890CT01OtherANTHEM BLUE CROSS
CT890000553Medicare ID - Type Unspecified364SP0809X
CT400000890CT01OtherANTHEM BLUE CROSS