Individual
MRS. KIMBERLY S WILLIAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPO, CFM
Contact information
Practice address
106 MEDICAL DRIVE, ELIZ CITY, NC 27909
(252) 338-3002
(252) 338-2902
Mailing address
106 MEDICAL DRIVE, PO BOX 1471, ELIZ CITY, NC 27909
(252) 338-3002
(252) 338-2902
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO03814
NC
224P00000X
Prosthetist
CPO03814
NC
332BC3200X
Customized Equipment (DME)
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0482P
BCBS
NC
01
—
384410
BCBS
VA
05
—
7701327
—
NC
05
—
9190511
—
VA
Enumeration date
08/14/2006
Last updated
12/09/2020
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