Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 082012779N6 | OR |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 082012779N6 | OR |
NPI | 1003970583 |
---|---|
Provider Name | Mrs. Kristi Ann Williams |
First Address | Portland, OR 97220-3873 |
Second Address | Portland, OR 97220-3873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069096 | (05) | OR |
S71512 | (02) |