MEDICARE: KIMBERLY M WILLIAMSON MSH , RD, LD/N

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	133V00000X	Registered Dietitian	ND5342	FL

General Provider Information

NPI Number	:	1730319856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M WILLIAMSON MSH , RD, LD/N

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S STE 220
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-724-2043
Fax Number	:	904-724-2013

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S STE 220
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2727
Country	:	US
Telephone Number	:	904-724-2043
Fax Number	:	904-724-2013

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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