MEDICARE: KEVIN WILLIAMSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	277226	SC

General Provider Information

NPI Number	:	1588469597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WILLIAMSON RN

Provider Business Mailing Address
First Line	:	136 SPORTHORSE LN
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-2930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 SPORTHORSE LN
Second Line	:
City	:	AIKEN
State	:	SC
Zip	:	29803-2930
Country	:	US
Telephone Number	:	803-295-6478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	01/20/2026

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