Healthcare Provider Details

I. General information

NPI: 1053730390
Provider Name (Legal Business Name): FELECIA WIMBERLY-GIBSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 RIDGE RD STE C
PARMA OH
44129-3169
US

IV. Provider business mailing address

5850 RIDGE RD
PARMA OH
44129-3169
US

V. Phone/Fax

Practice location:
  • Phone: 440-886-3150
  • Fax: 440-886-1636
Mailing address:
  • Phone: 440-886-3150
  • Fax: 440-886-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15849
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 15849-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.240900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: