Provider Demographics
NPI:1831071216
Name:CUMMINGS-WILLIAMS, KIM DEMETRIUS (MSN, RN HEALTH COACH)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:DEMETRIUS
Last Name:CUMMINGS-WILLIAMS
Suffix:
Gender:F
Credentials:MSN, RN HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21811 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2030
Mailing Address - Country:US
Mailing Address - Phone:917-749-7946
Mailing Address - Fax:
Practice Address - Street 1:21811 120TH AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-2030
Practice Address - Country:US
Practice Address - Phone:917-749-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3166136163W00000X
NYA-3730507174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163W00000XNursing Service ProvidersRegistered Nurse