Provider Demographics
NPI:1730319856
Name:WILLIAMSON, KIMBERLY M (MSH , RD, LD/N)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSH , RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 UNIVERSITY BLVD S STE 220
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2727
Mailing Address - Country:US
Mailing Address - Phone:904-724-2043
Mailing Address - Fax:904-724-2013
Practice Address - Street 1:3100 UNIVERSITY BLVD S STE 220
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2727
Practice Address - Country:US
Practice Address - Phone:904-724-2043
Practice Address - Fax:904-724-2013
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered