Individual provider Active NPI

Kennetha Williams, DNP, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1366787798
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
3013874 Issued in KY
Practice address
633 Baxter Ave
Louisville, KY 40204-1157
Phone
(502) 309-2408
NPI assigned
Dec 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3013874 KY Primary

Addresses

Primary practice location

633 Baxter Ave
Louisville, KY 40204-1157

Mailing address

633 Baxter Ave
Louisville, KY 40204-1157
Phone (502) 309-2408

Other practice location 1

2105 Crums Ln
Louisville, KY 40216-4231
Phone (502) 589-8600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191127001911 KY Practitioner - Nurse Practitioner 8123451473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seven Counties Services, IncGroup PAC ID 1759294424, 92 clinicians

Practice addresses (Care Compare)

530 S Jackson St
Louisville, KY 40202-1675
Phone (502) 589-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mandala House, LLC CurrentSince Jan 22, 2024 Accepting new patients
Seven Counties Services, Inc. CurrentSince Oct 7, 2019 Accepting new patients

Locations

10101 Linn Station Rd
Ste 600
Louisville, KY 40223
Phone (502) 858-9860

4710 Champions Trace Ln
Ste 102
Louisville, KY 40218
Phone (502) 454-6343

101 W Muhammad Ali Blvd
Louisville, KY 40202
Phone (502) 589-8615

10401 Linn Station Rd
Ste 100
Louisville, KY 40223

1190 E Broadway
Louisville, KY 40204
Phone (502) 309-2408

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

633 Baxter Ave
Louisville, KY 40204
Phone (502) 309-2408

2105 Crums Ln
Shively, KY 40216
Phone (502) 448-2007

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1366787798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 BAXTER AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041157",
            "telephone_number": "502-309-2408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 BAXTER AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402041157",
            "telephone_number": "502-309-2408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2105 Crums Ln",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402164231",
            "country_code": "US",
            "telephone_number": "502-589-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KENNETHA",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-12",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3013874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.