MEDICARE: KIMBERLY WILLIAMS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209-003787	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-265451	OTHER	IL	RN LICENSE
2	209-003787	OTHER	IL	APN LICENSE

General Provider Information

NPI Number	:	1770537532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WILLIAMS NP

Provider Business Mailing Address
First Line	:	2555 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2419
Country	:	US
Telephone Number	:	708-705-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2419
Country	:	US
Telephone Number	:	708-705-0406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	12/12/2017

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Directions to “ KIMBERLY WILLIAMS NP” Practice Location

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