Active NPI
Kimberly Sue Williston, RD
- Registered Dietitian
- Derry, NH
National Provider Identifier
1801107230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 414
- Practice address
- 40 Gaita Dr
Derry, NH 03038-6024 - Phone
- (603) 553-1011
- Fax
- (603) 537-0489
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 414 | NH | Primary |
| Registered Dietitian | 133V00000X | 2844 | MA |
Addresses
Primary practice location
40 Gaita Dr
Derry, NH 03038-6024
Mailing address
40 Gaita Dr
Derry, NH 03038-6024
Phone (603) 553-1011
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
| License | State | Type | Specialty |
|---|---|---|---|
| 414 | NH | MD | Mental Health Counselor |
| 2844 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1801107230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 GAITA DR",
"city": "DERRY",
"state": "NH",
"postal_code": "030386024",
"telephone_number": "603-553-1011",
"fax_number": "603-537-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 GAITA DR",
"city": "DERRY",
"state": "NH",
"postal_code": "030386024",
"telephone_number": "603-553-1011",
"fax_number": "603-537-0489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLISTON",
"first_name": "KIMBERLY",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-30",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NH",
"license": "414",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "2844",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Derry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.