Provider Demographics
NPI:1649217365
Name:WILLIAMS, CATHERINE A (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 NE MULBERRY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4533
Mailing Address - Country:US
Mailing Address - Phone:816-389-4137
Mailing Address - Fax:816-389-4140
Practice Address - Street 1:8929 PARALLEL PARKWAY
Practice Address - Street 2:PROVIDENCE HOSPITAL
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1787
Practice Address - Country:US
Practice Address - Phone:913-596-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO052169367500000X
KS54177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917879736Medicaid
MO826650635Medicare ID - Type Unspecified