Healthcare Provider Details

I. General information

NPI: 1639894710
Provider Name (Legal Business Name): GENA NICOLE WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GROSSER RD
GILBERTSVILLE PA
19525-9228
US

IV. Provider business mailing address

222 S BROAD MOUNTAIN AVE
FRACKVILLE PA
17931-2202
US

V. Phone/Fax

Practice location:
  • Phone: 484-498-6060
  • Fax:
Mailing address:
  • Phone: 570-985-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064087
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA064087
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: