Provider Demographics
NPI:1982076923
Name:WILLIAMSON, KAYLA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACPNC-AG
Mailing Address - Street 1:PO BOX 840020
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0020
Mailing Address - Country:US
Mailing Address - Phone:806-358-0200
Mailing Address - Fax:806-356-5590
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0200
Practice Address - Fax:806-356-5590
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX769662OtherMEDICARE
TX354803402Medicaid