Daphene Luvata Kimball-Butler, RN.PCM.CLC.SANE.

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

RN136141 Issued in GA

Practice address

4778 N Henry Blvd
Stockbridge, GA 30281-3566

Phone

(706) 650-5793

Fax

(770) 786-2223

NPI assigned

Feb 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 14

Addresses

Other identifiers 2

Other names 1

• Ms. Daphene Luvata Kimball-Williamson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264377600000",
    "number": "1669448643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 BLAKE AVE",
            "city": "PORTERDALE",
            "state": "GA",
            "postal_code": "300145016",
            "telephone_number": "706-650-5793",
            "fax_number": "770-786-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4778 N HENRY BLVD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302813566",
            "telephone_number": "706-650-5793",
            "fax_number": "770-786-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL-BUTLER",
        "first_name": "DAPHENE",
        "middle_name": "LUVATA",
        "name_prefix": "Ms.",
        "credential": "RN.PCM.CLC.SANE.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2010-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "GA",
            "license": "RN136141",
            "primary": true
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "GA",
            "license": "RN136141",
            "primary": false
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "GA",
            "license": "RN136141",
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "GA",
            "license": "RN136141",
            "primary": false
        },
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "GA",
            "license": "RN136141",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "GA",
            "license": "RN136141",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WX0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, High-Risk",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WP1700X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Perinatal",
            "state": "SC",
            "license": "R73283",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "SC",
            "license": "R73283",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000847459B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000847459A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAPHENE",
            "last_name": "KIMBALL-WILLIAMSON",
            "middle_name": "LUVATA",
            "prefix": "MS.",
            "credential": "RN.PCM.CLC.SANE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kids First Pediatric Group, LLC
• Lindsey Kiesgen, AU.D.
• Alen Crystal Kim
• Diana Kim, D.O.
• Sora Kim
• Nia Louise Kimbro, FNP
• Joshua A King, MD
• Karyn L King, LPC, CPCS
• Elicia Kinney
• Jamie Kirk, LMFT

• All providers in Stockbridge, GA
• Community Health Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.