MEDICARE: MRS. KIMBERLY WILLIAMSON PA-C

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	363A00000X	Physician Assistant	PA05996	TX

General Provider Information

NPI Number	:	1174845010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY WILLIAMSON PA-C

Provider Business Mailing Address
First Line	:	1614 SCRIPTURE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6340 N BEACH ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2622
Country	:	US
Telephone Number	:	817-514-8668
Fax Number	:

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	06/08/2017

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