Healthcare Provider Details

I. General information

NPI: 1356617815
Provider Name (Legal Business Name): CASSY JEAN WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PETERSON DR
ELIZABETHTOWN KY
42701-9370
US

IV. Provider business mailing address

201 PETERSON DR
ELIZABETHTOWN KY
42701-9370
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5900
  • Fax: 270-982-1284
Mailing address:
  • Phone: 707-655-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3013217
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3013217
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: