Provider Demographics
NPI:1992111629
Name:WILLIAMS, KASSANDRA KAY (PA-C)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 S OCCIDENTAL RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-9782
Mailing Address - Country:US
Mailing Address - Phone:989-506-0490
Mailing Address - Fax:
Practice Address - Street 1:5449 S OCCIDENTAL RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-9782
Practice Address - Country:US
Practice Address - Phone:517-264-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical