Provider Demographics
NPI:1235107004
Name:WILLIAMS, KIMBERLY M (CNM)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MAE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4502 OLD PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2585
Mailing Address - Country:US
Mailing Address - Phone:228-863-9977
Mailing Address - Fax:228-863-9912
Practice Address - Street 1:4502 OLD PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2585
Practice Address - Country:US
Practice Address - Phone:228-863-9977
Practice Address - Fax:228-863-9912
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876822367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07782252Medicaid
FL001174200Medicaid
FL001174200Medicaid