MEDICARE: DR. CHARLENE RUTH WILLIAMS FNP, PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC1500X	Community Health Nurse Practitioner	318213	CA
2	363LF0000X	Family Nurse Practitioner	883891	NV
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	883891	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP957Z	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1972649275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLENE RUTH WILLIAMS FNP, PSYD

Provider Business Mailing Address
First Line	:	5221 DAVIDSON RD
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-9704
Country	:	US
Telephone Number	:	530-642-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 PLACERVILLE DR STE 1B
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4200
Country	:	US
Telephone Number	:	530-621-6290
Fax Number	:	530-622-1293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/24/2025

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