Provider Demographics
NPI:1346823960
Name:WILLIAMS, KYLE DAVID
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:3491 E HARMONY RD STE 230
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8824
Practice Address - Country:US
Practice Address - Phone:970-449-0285
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X390200000X
COPA.0008557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program