Provider Demographics
NPI:1447898226
Name:WILLIAMS, KATELYN (FNP-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 HAWTHORNE AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5378
Mailing Address - Country:US
Mailing Address - Phone:503-814-4440
Mailing Address - Fax:503-814-4444
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5378
Practice Address - Country:US
Practice Address - Phone:503-814-4440
Practice Address - Fax:503-814-4444
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200941744RN163W00000X
OR202000576NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse