Individual provider Active NPI

Kimberly J Williams, LPN, RCS

  • Licensed Practical Nurse
  • Janesville, WI
National Provider Identifier
1750533873
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
309781-031 Issued in WI
Practice address
1305 Camelot Dr
Janesville, WI 53548-1495
Phone
(608) 758-2429
NPI assigned
Oct 21, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 309781-031 WI Primary

Addresses

Primary practice location

1305 Camelot Dr
Janesville, WI 53548-1495

Mailing address

4124 Bordeaux Dr
Janesville, WI 53546-1739
Phone (608) 751-6974

Other identifiers 1

IdentifierTypeStateIssuer
309781-031OtherWIDEPARTMENT OF REGULATION AND LICENSING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
309781-031WIMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1750533873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4124 BORDEAUX DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535461739",
            "telephone_number": "608-751-6974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 CAMELOT DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535481495",
            "telephone_number": "608-758-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LPN, RCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "309781-031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF REGULATION AND LICENSING",
            "identifier": "309781-031",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; 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.