MEDICARE: MRS. KASEY DRAKE WILLIAMS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497876924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KASEY DRAKE WILLIAMS MA

Provider Business Mailing Address
First Line	:	3004 ATHERLY RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5052
Country	:	US
Telephone Number	:	904-838-6268
Fax Number	:	904-207-7643

Provider Business Practice Location Address
First Line	:	3004 ATHERLY RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5052
Country	:	US
Telephone Number	:	904-838-6268
Fax Number	:	904-207-7643

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/09/2007

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