Healthcare Provider Details

I. General information

NPI: 1588051981
Provider Name (Legal Business Name): KRISTEN SHAHEEN WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KRISTEN FRANCES SHAHEEN

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 COPPERFIELD BLVD NE SUITE 102
CONCORD NC
28025-2441
US

IV. Provider business mailing address

270 COPPERFIELD BLVD NE STE 102
CONCORD NC
28025-2443
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-6521
  • Fax:
Mailing address:
  • Phone: 252-904-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: