Provider Demographics
NPI:1194147868
Name:WIMBERLEY, ASHTON
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:WIMBERLEY
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 1:7515 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:PHIL CAMPBELL
Mailing Address - State:AL
Mailing Address - Zip Code:35581-6122
Mailing Address - Country:US
Mailing Address - Phone:256-768-8764
Mailing Address - Fax:256-768-9323
Practice Address - Street 1:7515 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:PHIL CAMPBELL
Practice Address - State:AL
Practice Address - Zip Code:35581-6122
Practice Address - Country:US
Practice Address - Phone:256-768-8764
Practice Address - Fax:256-768-9323
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily