Active NPI
Kellie Williams, M.D.
- Pediatrics Physician
- Conroe, TX
National Provider Identifier
1720089980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- K7947
- Practice address
- 404 River Pointe Dr
100
Conroe, TX 77304-2836 - Phone
- (936) 756-8108
- NPI assigned
- Aug 9, 2005
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | K7947 | TX | Primary |
Addresses
Primary practice location
404 River Pointe Dr
100
Conroe, TX 77304-2836
Mailing address
PO Box 841969
Dallas, TX 75284-1969
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K7947 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omar a. Gomez, M.D.,P.a. | Pediatrics | Past | Accepting new patients |
| Omar a. Gomez, M.D.,P.a. | Pediatrics | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720089980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 841969",
"city": "DALLAS",
"state": "TX",
"postal_code": "752841969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 RIVER POINTE DR",
"address_2": "100",
"city": "CONROE",
"state": "TX",
"postal_code": "773042836",
"telephone_number": "936-756-8108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KELLIE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "K7947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.