Provider Demographics
NPI:1629029582
Name:WILLIAMS, KEITH ALLEN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NORTH DAVIS STREET
Mailing Address - Street 2:BUILDING B, SUITE 315
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-253-1040
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:515 W 6TH ST # MC-66
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4324
Practice Address - Country:US
Practice Address - Phone:904-253-1040
Practice Address - Fax:904-253-1961
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2854262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3051374-00Medicaid
FL305137400Medicaid
FL305137400Medicaid
FLU0367YMedicare PIN
FLU0367ZMedicare ID - Type Unspecified
FLU037ZMedicare PIN