Active NPI
Kelly Williams
- Registered Dietitian
- Waterford, CT
National Provider Identifier
1497460869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1267
- Practice address
- 169 Stoneheights Dr
Waterford, CT 06385-1951 - Phone
- (203) 988-1267
- NPI assigned
- Jan 19, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1582 | CT | |
| Registered Dietitian | 133V00000X | LDN01188 | RI | |
| Registered Dietitian | 133V00000X | 1267 | NH | Primary |
Addresses
Primary practice location
169 Stoneheights Dr
Waterford, CT 06385-1951
Mailing address
169 Stoneheights Dr
Waterford, CT 06385-1951
Phone (203) 988-1267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDN01188 | RI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| South East Alaska Regional Health Consortium | Past | Accepting new patients | |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Locations
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
Organizations & group practices 6
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.
-
- Community/Behavioral Health Agency
- Petersburg, AK
- NPI 1174108880
-
- Clinic/Center
- Juneau, AK
- NPI 1427941343
-
- Clinic/Center
- Wrangel, AK
- NPI 1487836391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1497460869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 STONEHEIGHTS DR",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851951",
"telephone_number": "203-988-1267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 STONEHEIGHTS DR",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851951",
"telephone_number": "203-988-1267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-19",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CT",
"license": "1582",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "RI",
"license": "LDN01188",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NH",
"license": "1267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.