Healthcare Provider Details

I. General information

NPI: 1346005220
Provider Name (Legal Business Name): KYLLA DANIELLE WILLIAMS DNP, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 N CLYDE MORRIS BLVD STE 140
DAYTONA BEACH FL
32117-5534
US

IV. Provider business mailing address

1737 N CLYDE MORRIS BLVD STE 140
DAYTONA BEACH FL
32117-5534
US

V. Phone/Fax

Practice location:
  • Phone: 386-262-1627
  • Fax: 386-262-1628
Mailing address:
  • Phone: 386-262-1627
  • Fax: 386-262-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11031360
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11031360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: