Provider Demographics
NPI:1679718415
Name:WILLIAMS, KELLY M (MD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:MORRISSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:377 SYLVAN LAKE RD
Mailing Address - Street 2:STE 210
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-6779
Mailing Address - Country:US
Mailing Address - Phone:970-926-9226
Mailing Address - Fax:970-926-8755
Practice Address - Street 1:1140 EDWARDS VILLAGE BLVD S-B200
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-2736
Practice Address - Country:US
Practice Address - Phone:970-926-9226
Practice Address - Fax:970-926-8755
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.015265207R00000X
CODR0052504207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine