Healthcare Provider Details

I. General information

NPI: 1790660769
Provider Name (Legal Business Name): VEYONTE R WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 KIOWA AVE
ORANGE PARK FL
32065-8404
US

IV. Provider business mailing address

2851 KIOWA AVE
ORANGE PARK FL
32065-8404
US

V. Phone/Fax

Practice location:
  • Phone: 904-428-4967
  • Fax:
Mailing address:
  • Phone: 904-428-4967
  • Fax: 904-428-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: