Active NPI
Kathleen Renee Williams, DC
- Chiropractor
- Eden Prairie, MN
National Provider Identifier
1235705146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6874
- Practice address
- 6805 Flying Cloud Dr
Eden Prairie, MN 55344-3418 - Phone
- (952) 255-6980
- NPI assigned
- Jun 1, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6874 | MN | Primary |
Addresses
Primary practice location
6805 Flying Cloud Dr
Eden Prairie, MN 55344-3418
Mailing address
6805 Flying Cloud Dr
Eden Prairie, MN 55344-3418
Phone (952) 255-6980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210610001868 | MN | Practitioner - Chiropractic | 6305246471 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697068800000",
"number": "1235705146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6805 FLYING CLOUD DR",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443418",
"telephone_number": "952-255-6980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6805 FLYING CLOUD DR",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443418",
"telephone_number": "952-255-6980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KATHLEEN",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-01",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "6874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.