Provider Demographics
NPI:1184650194
Name:WILLIAMS, KIMBERLY J (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-0067
Mailing Address - Country:US
Mailing Address - Phone:717-436-5578
Mailing Address - Fax:
Practice Address - Street 1:HC 63 BOX 48C
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-9049
Practice Address - Country:US
Practice Address - Phone:717-436-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA-000783-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP68444Medicare UPIN
PA077621Medicare ID - Type Unspecified