Healthcare Provider Details

I. General information

NPI: 1629029582
Provider Name (Legal Business Name): KEITH ALLEN WILLIAMS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 6TH ST # MC-66
JACKSONVILLE FL
32206-4324
US

IV. Provider business mailing address

921 NORTH DAVIS STREET BUILDING B, SUITE 315
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1040
  • Fax: 904-253-1961
Mailing address:
  • Phone: 904-253-1040
  • Fax: 904-253-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2854262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: