Provider Demographics
NPI:1992006506
Name:WILLIAMS, KELLIE SUE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:KELLIE
Other - Middle Name:SUE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRATZER
Mailing Address - Street 1:305 S LINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4605
Mailing Address - Country:US
Mailing Address - Phone:352-344-4791
Mailing Address - Fax:352-344-3822
Practice Address - Street 1:828 E SAVOY ST
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8766
Practice Address - Country:US
Practice Address - Phone:404-357-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012874208G00000X, 363LF0000X
GARN094494NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1992006506Medicaid
FLXJYGAOtherBLUE SHIELD
FL110883800Medicaid