Healthcare Provider Details

I. General information

NPI: 1265276406
Provider Name (Legal Business Name): KELSY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SAXONY RD STE 103
ENCINITAS CA
92024-6779
US

IV. Provider business mailing address

169 SAXONY RD STE 103
ENCINITAS CA
92024-6779
US

V. Phone/Fax

Practice location:
  • Phone: 760-688-4080
  • Fax:
Mailing address:
  • Phone: 760-688-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95203976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: