Basic Information
| Provider Information | |||||||||
| NPI: | 1659444909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | MOHAVE MENTAL HEALTH CLINIC INC | ||||||||
| Address2: | 1743 SYCAMORE AVE | ||||||||
| City: | KINSMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287578111 | ||||||||
| FaxNumber: | 9287573256 | ||||||||
| Practice Location | |||||||||
| Address1: | MOHAVE MENTAL HEALTH CLINIC INC | ||||||||
| Address2: | 1145 MARINA BLVD | ||||||||
| City: | BULLHEAD CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287585905 | ||||||||
| FaxNumber: | 9287573256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN139215 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AP2441 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | AP2441 | 01 | AZ | AZ BOARD OF NURSING | OTHER | MW1466247 | 01 | DEA | OTHER |