Healthcare Provider Details

I. General information

NPI: 1124064324
Provider Name (Legal Business Name): PATRICIA WIMBERLY F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOFIELD RD BLGD 1178
FORT SAM HOUSTON TX
78234-7577
US

IV. Provider business mailing address

3100 SCHOFIELD ROAD, BLGD 1178 FORT SAM HOUSTON ADOLESCENT CLINIC MEDICINE CLINIC
FORT SAM HOUSTON TX
78234-6400
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-3160
  • Fax: 210-861-2270
Mailing address:
  • Phone: 210-916-3160
  • Fax: 210-861-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2005003696-22
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: