MEDICARE: CHARLOTTE WRIGHT WILLIAMSON

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	363LF0000X	Family Nurse Practitioner	1108828	TX

General Provider Information

NPI Number	:	1376251090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE WRIGHT WILLIAMSON

Provider Business Mailing Address
First Line	:	6210 E HWY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1142
Country	:	US
Telephone Number	:	512-483-9596
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	8901 VERTEX BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78747-2792
Country	:	US
Telephone Number	:	512-231-5150
Fax Number	:	512-406-6262

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

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	01/15/2025

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