Blake Jerald Williamson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2003018093 Issued in MO

Practice address

14611 W 50TH St
Shawnee, KS 66216-5116

Phone

(913) 248-1903

NPI assigned

Apr 23, 2012

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1710244124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14611 W 50TH ST",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662165116",
            "telephone_number": "913-248-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14611 W 50TH ST",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662165116",
            "telephone_number": "913-248-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "BLAKE",
        "middle_name": "JERALD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-23901",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2003018093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Williams
• Malissa R Williams
• Nathan Williams, LPC
• Robyn Diane Williams, DPT
• Amy R Williamsen, PHARM.D.
• Randa Williamson
• Willowtree Supports Inc
• Alexandra Wilson
• Lisa Kay Wilson, LMSW
• Paula Lorene Wilson, LCMFT

• Family Medicine Physician in Shawnee, KS
• Providers in Shawnee, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.