Healthcare Provider Details

I. General information

NPI: 1295844488
Provider Name (Legal Business Name): JULIE JIMERSON-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S STATE ROUTE 291
INDEPENDENCE MO
64057-1201
US

IV. Provider business mailing address

3016 SW SADDLEWOOD PL
LEES SUMMIT MO
64081-3826
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-9328
  • Fax:
Mailing address:
  • Phone: 816-304-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: