Provider Demographics
NPI:1215153366
Name:WILLIAMS, KIMBERLY A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 1900
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-0030
Mailing Address - Country:US
Mailing Address - Phone:228-218-1707
Mailing Address - Fax:
Practice Address - Street 1:180 DEBUYS RD.
Practice Address - Street 2:SUITE 215
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-861-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR842455363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health