Provider Demographics
NPI:1396969358
Name:WILLIAMS, KATHLEEN LOUISE (CPNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-924-9337
Mailing Address - Fax:916-924-8281
Practice Address - Street 1:425 UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-924-9337
Practice Address - Fax:916-924-8281
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA338137OtherLICENSE NUMBER
CA6551OtherFURNISHING NUMBER