Healthcare Provider Details

I. General information

NPI: 1376779066
Provider Name (Legal Business Name): KERRY MICHELLE WILLIAMS BC-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE STE 1200
LOS ANGELES CA
90033-2467
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-2987
  • Fax:
Mailing address:
  • Phone: 323-268-2200
  • Fax: 323-268-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP18697
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: