Healthcare Provider Details

I. General information

NPI: 1245325711
Provider Name (Legal Business Name): KATHY YVONNE WILLIAMS CPM-TN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 LAKEVIEW RD
SPRINGFIELD TN
37172-6620
US

IV. Provider business mailing address

6010 LAKEVIEW RD
SPRINGFIELD TN
37172-6620
US

V. Phone/Fax

Practice location:
  • Phone: 615-838-8300
  • Fax: 615-384-1457
Mailing address:
  • Phone: 615-838-8300
  • Fax: 615-384-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT000031310
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM000000020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: