Provider Demographics
NPI:1174072672
Name:KADY WILLIAMS LLC
Entity type:Organization
Organization Name:KADY WILLIAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KADY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:719-568-8218
Mailing Address - Street 1:147 S RANCHO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-4047
Mailing Address - Country:US
Mailing Address - Phone:719-568-8218
Mailing Address - Fax:
Practice Address - Street 1:147 S RANCHO VISTA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-4047
Practice Address - Country:US
Practice Address - Phone:719-568-8218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KADY WILLIAMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991676-NP261QM0855X
CO00991676-NP261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO482544Medicaid