Provider Demographics
NPI:1851640460
Name:WILLIAMS, KIMBERLY (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC
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 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:805 FARSON STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714
Practice Address - Country:US
Practice Address - Phone:740-423-3202
Practice Address - Fax:740-423-3212
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15348-NP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097310Medicaid
WV3810026998Medicaid
OH0097310Medicaid
OH0097310Medicaid
OHH212311Medicare PIN