Provider Demographics
NPI:1710944731
Name:WILLIAMS, KIERSTEN WILSON (MD)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:WILSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-322-2240
Mailing Address - Fax:303-322-9260
Practice Address - Street 1:2055 HIGH ST
Practice Address - Street 2:#140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-322-2240
Practice Address - Fax:303-322-9260
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40673207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1710944731Medicaid
KS200739380AMedicaid
WY1710944731Medicaid
NE10025711400Medicaid
CO76876331Medicaid
COCO300010Medicare PIN
NE10025711400Medicaid
KS200739380AMedicaid