Healthcare Provider Details

I. General information

NPI: 1013269141
Provider Name (Legal Business Name): KATHY WILLIAMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2012
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WEST MAIN ST
NEWARK OH
43055
US

IV. Provider business mailing address

1320 WEST MAIN ST
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4226
  • Fax: 220-564-4217
Mailing address:
  • Phone: 220-564-4226
  • Fax: 220-564-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: