Provider Demographics
NPI:1861689390
Name:WILLIAMS, KATHERINE JEAN (PAC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1023
Mailing Address - Country:US
Mailing Address - Phone:805-497-7015
Mailing Address - Fax:805-497-7315
Practice Address - Street 1:375 ROLLING OAKS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1023
Practice Address - Country:US
Practice Address - Phone:805-497-7015
Practice Address - Fax:805-497-7315
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028606363A00000X
CA53416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB259138Medicare UPIN