Provider Demographics
NPI:1063724383
Name:WILLIAMS, KATIE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-561-7566
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-561-7566
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner