Breanne Williamson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9158 Issued in AZ

Practice address

440 N Navajo Dr
Page, AZ 86040-0950

Phone

(352) 430-4493

NPI assigned

Apr 27, 2020

Last updated

Aug 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: breanne.williamson.p1@direct.canyonlands.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Canyonlands Community Health Care

  • Family Medicine Physician
  • Page, AZ
  • NPI 1609966860
  Medicare reassignment
• Canyonlands Community Health Care

  dba Canyonlands Health Care - Clifton

  • Federally Qualified Health Center (FQHC)
  • Clifton, AZ
  • NPI 1134568660
  NPD
• Canyonlands Community Health Care

  dba Canyonlands Healthcare - Adams Chiropractic

  • Federally Qualified Health Center (FQHC)
  • Page, AZ
  • NPI 1457187981
  NPD
• Canyonlands Community Health Care

  dba Chilchinbeto Clinic

  • Community Health Clinic/Center
  • Chilchinbeto, AZ
  • NPI 1154380392
  NPD (past)
• Canyonlands Community Health Care

  dba Canyonlands Healthcare Globe

  • Federally Qualified Health Center (FQHC)
  • Globe, AZ
  • NPI 1417218876
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1417578832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 LANDING VW",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327782050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 N NAVAJO DR",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860400950",
            "telephone_number": "352-430-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "BREANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-27",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "9158",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9113136",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Page, AZ
• Providers in Page, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.