MEDICARE: KRISTIN KEOUGH WILLIAMS PSYD

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	103TC0700X	Clinical Psychologist	PY8200	FL

General Provider Information

NPI Number	:	1598068223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN KEOUGH WILLIAMS PSYD

Provider Business Mailing Address
First Line	:	4100 W KENNEDY BLVD STE 223
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-846-2690
Fax Number	:	138-407-6117

Provider Business Practice Location Address
First Line	:	4100 W KENNEDY BLVD STE 223
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2244
Country	:	US
Telephone Number	:	813-846-2690
Fax Number	:

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

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	01/04/2021

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