Provider Demographics
NPI:1366328858
Name:WILLIAMS, KIMBERLY DETRICE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DETRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-5336
Mailing Address - Country:US
Mailing Address - Phone:903-371-3413
Mailing Address - Fax:
Practice Address - Street 1:725 SCHOOL ST
Practice Address - Street 2:MOBILE TRAVEL
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662
Practice Address - Country:US
Practice Address - Phone:903-371-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health