Provider Demographics
NPI:1891160040
Name:KIMBERLY L. WILLIAMS
Entity Type:Organization
Organization Name:KIMBERLY L. WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CST/CSFA
Authorized Official - Phone:307-259-5667
Mailing Address - Street 1:4877 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7468
Mailing Address - Country:US
Mailing Address - Phone:307-259-5667
Mailing Address - Fax:
Practice Address - Street 1:4877 W 31ST ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7468
Practice Address - Country:US
Practice Address - Phone:307-259-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ163303282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital