Active NPI
Warren Keith Williamson, P.A.
- Physician Assistant
- Phoenix, AZ
National Provider Identifier
1912951823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2892
- Practice address
- 220 South 12TH Avenue
Maricopa County Health Care for the Homeless
Phoenix, AZ 85007-3101 - Phone
- (602) 372-2117
- Fax
- (602) 372-2120
- NPI assigned
- May 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2892 | AZ | Primary |
Addresses
Primary practice location
220 South 12TH Avenue
Maricopa County Health Care for the Homeless
Phoenix, AZ 85007-3101
Mailing address
220 South 12TH Avenue
Maricopa County Health Care for the Homeless
Phoenix, AZ 85007-3101
Phone (602) 372-2117
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 943896 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2892 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1912951823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 SOUTH 12TH AVENUE",
"address_2": "MARICOPA COUNTY HEALTH CARE FOR THE HOMELESS",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850073101",
"telephone_number": "602-372-2117",
"fax_number": "602-372-2120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 SOUTH 12TH AVENUE",
"address_2": "MARICOPA COUNTY HEALTH CARE FOR THE HOMELESS",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850073101",
"telephone_number": "602-372-2117",
"fax_number": "602-372-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMSON",
"first_name": "WARREN",
"middle_name": "KEITH",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "2892",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "943896",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.