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: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRISON AVE STE 600
BOSTON MA
02111-1995
US

IV. Provider business mailing address

13885 SAINT JOHN RD
RINEYVILLE KY
40162-9719
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax: 844-705-0129
Mailing address:
  • Phone: 270-312-8189
  • 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: