MEDICARE: KIMBERLY S WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZN0300X	Nephrology Specialist/Technologist	025637	LA
2	207RN0300X	Nephrology Physician	025637	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	3A414	OTHER	LA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	51006924	OTHER	AL	BLUE CROSS OF ALABAMA

General Provider Information

NPI Number	:	1174543193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY S WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	42286 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	985-902-8853
Fax Number	:	985-902-8854

Provider Business Practice Location Address
First Line	:	42286 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	985-902-8853
Fax Number	:	985-902-8854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/24/2024

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Directions to “ KIMBERLY S WILLIAMS M.D.” Practice Location

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