MEDICARE: KASSANDRA WILLIAMS PA-C

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	363A00000X	Physician Assistant	2022039976	MO

General Provider Information

NPI Number	:	1699495770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA WILLIAMS PA-C

Provider Business Mailing Address
First Line	:	10012 KENNERLY RD STE 300
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2197
Country	:	US
Telephone Number	:	314-692-2807
Fax Number	:	314-991-0727

Provider Business Practice Location Address
First Line	:	10012 KENNERLY RD STE 300
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2197
Country	:	US
Telephone Number	:	314-692-2807
Fax Number	:	314-991-0727

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	06/19/2026

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