1750794111 NPI number — RENAE JOYCE WILLIAMSON MS, ATC

Table of content: RENAE JOYCE WILLIAMSON MS, ATC (NPI 1750794111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750794111 NPI number — RENAE JOYCE WILLIAMSON MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
RENAE
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750794111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 E 29TH ST N
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67226-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 E 29TH ST N
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-219-8299
Provider Business Practice Location Address Fax Number:
316-219-5899
Provider Enumeration Date:
06/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  24-00803 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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