Provider Demographics
NPI:1447267752
Name:WILLIAMS, KRISTEN (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-375-6817
Mailing Address - Fax:814-375-0922
Practice Address - Street 1:5690 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-375-6817
Practice Address - Fax:814-375-0922
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP-008208363LA2200X
PASP011266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088056Medicare ID - Type Unspecified
PAQ35775Medicare UPIN