Healthcare Provider Details

I. General information

NPI: 1699338137
Provider Name (Legal Business Name): KATHLEEN ANN WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HAMPDEN AVE STE 200
ENGLEWOOD CO
80113-2885
US

IV. Provider business mailing address

828 N BROADWAY APT 311
DENVER CO
80203-2875
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007190
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: