Healthcare Provider Details

I. General information

NPI: 1679527147
Provider Name (Legal Business Name): KIMBERLY WHEELER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SAN ANTONIO ST
LOCKHART TX
78644-2421
US

IV. Provider business mailing address

1009 W SAN ANTONIO ST
LOCKHART TX
78644-2421
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-5247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM2198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: