Provider Demographics
NPI:1659444909
Name:WILLIAMS, SANDRA KAY (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:WILLIAMS
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Gender:F
Credentials:APRN BC
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Mailing Address - Street 1:MOHAVE MENTAL HEALTH CLINIC INC
Mailing Address - Street 2:1743 SYCAMORE AVE
Mailing Address - City:KINSMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:MOHAVE MENTAL HEALTH CLINIC INC
Practice Address - Street 2:1145 MARINA BLVD
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-5905
Practice Address - Fax:928-757-3256
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AZRN139215363L00000X
AZAP2441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP2441OtherAZ BOARD OF NURSING
MW1466247OtherDEA