Healthcare Provider Details

I. General information

NPI: 1699788372
Provider Name (Legal Business Name): KIMBERLY S WILLIAMSON CPO, CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MEDICAL DRIVE
ELIZ CITY NC
27909
US

IV. Provider business mailing address

106 MEDICAL DRIVE PO BOX 1471
ELIZ CITY NC
27909
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-3002
  • Fax: 252-338-2902
Mailing address:
  • Phone: 252-338-3002
  • Fax: 252-338-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03814
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03814
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: