Provider Demographics
NPI:1992173652
Name:WILLIAMS, KIMECO (FNP)
Entity type:Individual
Prefix:
First Name:KIMECO
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 N BRAESWOOD BLVD APT 460
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2950
Mailing Address - Country:US
Mailing Address - Phone:225-223-7676
Mailing Address - Fax:
Practice Address - Street 1:12850 MEMORIAL DR STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4973
Practice Address - Country:US
Practice Address - Phone:832-827-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily