=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598692329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COPPER MOUNTAIN CLINIC-THATCHER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2026
-----------------------------------------------------
Last Update Date | 05/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1013 N COLLEGE AVE SUITE 104
-----------------------------------------------------
City | THATCHER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-348-3960
-----------------------------------------------------
Fax | 844-665-7939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 S 20TH AVE
-----------------------------------------------------
City | SAFFORD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85546-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-348-4000
-----------------------------------------------------
Fax | 844-665-7939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP & CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | KATHLEEN LOUISE WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-348-4060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------