Provider Demographics
NPI:1760212419
Name:WILLIAMS, KIMBERLY LASHON (APRN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LASHON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAGNOLIA TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-5826
Mailing Address - Country:US
Mailing Address - Phone:229-560-7915
Mailing Address - Fax:
Practice Address - Street 1:21 MAGNOLIA TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-5826
Practice Address - Country:US
Practice Address - Phone:229-560-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily