Healthcare Provider Details

I. General information

NPI: 1093873721
Provider Name (Legal Business Name): KIMBERLY WILLIAMS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY WESLEY D.P.M.

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

IV. Provider business mailing address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-7848
  • Fax: 314-367-2985
Mailing address:
  • Phone: 314-367-7848
  • Fax: 314-367-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2013007946
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: