Healthcare Provider Details

I. General information

NPI: 1740903848
Provider Name (Legal Business Name): KELLI MONIQUE WILLIAMS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 CHRISTENSEN RD STE 200
TUKWILA WA
98188-2925
US

IV. Provider business mailing address

9131 DOWNING ST
ROSENBERG TX
77469-2387
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax:
Mailing address:
  • Phone: 281-677-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1232958
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70130110
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10061799
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: