Kimberly Ellison Wilson, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-078924 Issued in AL

Practice address

1325 McFarland Blvd
Suite 104
Northport, AL 35476-3270

Phone

(205) 330-5266

Fax

(205) 330-9915

NPI assigned

Aug 15, 2007

Last updated

Sep 25, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• SLCM LLC

  dba NorthRiver Primary Care Associates

  • Family Medicine Physician
  • Northport, AL
  • NPI 1336474964
  Medicare reassignment NPD
• Steve R Lovelady MD LLC

  • Family Medicine Physician
  • Northport, AL
  • NPI 1851467146
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1285826057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 MCFARLAND BLVD",
            "address_2": "SUITE 104",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763270",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 MCFARLAND BLVD",
            "address_2": "SUITE 104",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763270",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "ELLISON",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-15",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-078924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "511-00428",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115069/1336474964",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janie Williams
• Kineta L Williams, LICSW
• Laquanya Remique Williams, OTR
• Larry D Williams Jr.
• Robin Williams
• Rachel Windle, CRNP
• Kiana Winston, LMSW
• Nicholas Matthew Witucki, PHARM D.
• Mark A Woods, MD
• Selina Greathouse Woolverton, P.A.

• Family Nurse Practitioner in Northport, AL
• Providers in Northport, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.