Provider Demographics
NPI:1003970583
Name:WILLIAMS, KRISTI ANN (PMHNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 NE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3873
Mailing Address - Country:US
Mailing Address - Phone:503-261-6179
Mailing Address - Fax:503-253-8020
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-261-6179
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR082012779N6163WC1500X, 163WP0808X, 363LC1500X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069096Medicaid
OR069096Medicaid
OR114744Medicare ID - Type Unspecified