Healthcare Provider Details

I. General information

NPI: 1750569331
Provider Name (Legal Business Name): KELLE PATRICE WILLIAMS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 RIVER PARK DR SUITE 206L
SACRAMENTO CA
95815-4612
US

IV. Provider business mailing address

1555 RIVER PARK DR SUITE 206L
SACRAMENTO CA
95815-4612
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-6023
  • Fax: 916-921-1492
Mailing address:
  • Phone: 916-921-6023
  • Fax: 916-921-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number473
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA5001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: