Provider Demographics
NPI:1871049098
Name:WILLIAMS, KIRSTIN SUE (FNP)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 176TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-9201
Mailing Address - Country:US
Mailing Address - Phone:253-792-6527
Mailing Address - Fax:253-459-7823
Practice Address - Street 1:113 RUBY STREET
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:AR
Practice Address - Zip Code:71764
Practice Address - Country:US
Practice Address - Phone:870-786-9114
Practice Address - Fax:870-786-5530
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily