Healthcare Provider Details

I. General information

NPI: 1346547361
Provider Name (Legal Business Name): KRISTI LYNN WILLIAMSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NORTH ST
BRISTOL VA
24201-3274
US

IV. Provider business mailing address

149 CONLEY ST
LEBANON VA
24266-4655
US

V. Phone/Fax

Practice location:
  • Phone: 276-669-4711
  • Fax:
Mailing address:
  • Phone: 276-701-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number0131000561
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: