Healthcare Provider Details

I. General information

NPI: 1174072672
Provider Name (Legal Business Name): KADY WILLIAMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S RANCHO VISTA DR
PUEBLO CO
81007-4047
US

IV. Provider business mailing address

147 S RANCHO VISTA DR
PUEBLO CO
81007-4047
US

V. Phone/Fax

Practice location:
  • Phone: 719-568-8218
  • Fax:
Mailing address:
  • Phone: 719-568-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number00991676-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0991676-NP
License Number StateCO

VIII. Authorized Official

Name: MRS. KADY WILLIAMS
Title or Position: PSYCHIATRIC MENTAL HEALTH NP
Credential: PMHNP
Phone: 719-568-8218