Provider Demographics
NPI:1942874144
Name:WILLIAMS, KIMBERLEE SUE (BHCM I)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BHCM I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 NE FLOWER MOUND RD LOT 70
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-7205
Mailing Address - Country:US
Mailing Address - Phone:330-219-3311
Mailing Address - Fax:
Practice Address - Street 1:1307 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7231
Practice Address - Country:US
Practice Address - Phone:580-355-7500
Practice Address - Fax:580-355-7502
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator