Individual
KIMBERLY ANNE WILMOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1336 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4535
(770) 461-1238
Mailing address
1336 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4535
(770) 461-1238
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN122557
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003187048A
—
GA
05
—
003187048B
—
GA
Enumeration date
01/10/2017
Last updated
06/02/2017
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