Provider Demographics
NPI:1124064324
Name:WIMBERLY, PATRICIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SCHOFIELD ROAD, BLGD 1178
Mailing Address - Street 2:FORT SAM HOUSTON ADOLESCENT CLINIC MEDICINE CLINIC
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6400
Mailing Address - Country:US
Mailing Address - Phone:210-916-3160
Mailing Address - Fax:210-861-2270
Practice Address - Street 1:3100 SCHOFIELD RD
Practice Address - Street 2:BLGD 1178
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7577
Practice Address - Country:US
Practice Address - Phone:210-916-3160
Practice Address - Fax:210-861-2270
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2005003696-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ60320Medicare UPIN
TX00532TMedicare ID - Type UnspecifiedMEDICARE GROUP