Healthcare Provider Details

I. General information

NPI: 1821825241
Provider Name (Legal Business Name): KHEYANNE RASHAD WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

1501 ALHAMBRA CREST DR
RUSKIN FL
33570-7915
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax: 813-661-6334
Mailing address:
  • Phone: 941-268-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11035439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: