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General NPI Number Information
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NPI Number | 1174072672
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Entity Type | Organization
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Legal Business Name | KADY WILLIAMS LLC
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Dates
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Enumeration Date | 09/25/2016
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Last Update Date | 09/25/2016
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Provider Practice Location Address
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Address Line | 147 S RANCHO VISTA DR
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City | PUEBLO
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State | CO
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Zip | 81007-4047
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Country | US
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Telephone | 719-568-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 147 S RANCHO VISTA DR
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City | PUEBLO
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State | CO
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Zip | 81007-4047
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Country | US
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Telephone | 719-568-8218
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NP
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Name | MRS. KADY WILLIAMS
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Credential | PMHNP
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Telephone | 719-568-8218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 0991676-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 00991676-NP
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License Number State | CO
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