Healthcare Provider Details

I. General information

NPI: 1528504131
Provider Name (Legal Business Name): KIMBERLY WILLIAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W ARMITAGE AVE
CHICAGO IL
60622-1176
US

IV. Provider business mailing address

1919 W ARMITAGE AVE
CHICAGO IL
60622-1176
US

V. Phone/Fax

Practice location:
  • Phone: 773-466-2625
  • Fax: 847-262-3131
Mailing address:
  • Phone: 773-466-2625
  • Fax: 847-262-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015410
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: