Provider Demographics
NPI:1679059240
Name:WILLIAMS, CAITLYN JUSTINE (PA)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:JUSTINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:JUSTINE
Other - Last Name:ASBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:380 SUMMIT AVENUE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-6700
Practice Address - Country:US
Practice Address - Phone:800-318-1794
Practice Address - Fax:234-285-6816
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2179363AM0700X
363AM0700X
OH50.006522RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310839Medicaid