Healthcare Provider Details

I. General information

NPI: 1982243721
Provider Name (Legal Business Name): AIMEE ELIZABETH WILLIAMSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE ELIZABETH RODDY APRN

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5661
  • Fax: 859-323-6411
Mailing address:
  • Phone: 314-268-4110
  • Fax: 314-268-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018002345
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4012335
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: