Provider Demographics
NPI:1194717900
Name:WILLIAMS, MEREDITH S (C-PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:C-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4204
Mailing Address - Country:US
Mailing Address - Phone:970-667-3116
Mailing Address - Fax:970-669-0159
Practice Address - Street 1:1708 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4204
Practice Address - Country:US
Practice Address - Phone:970-667-3116
Practice Address - Fax:970-669-0159
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1890363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS80194Medicare ID - Type UnspecifiedMEDICARE #
CO519508Medicare UPIN