MEDICARE: MRS. PATRICIA WIMBERLY F.N.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2005003696-22	TX

General Provider Information

NPI Number	:	1124064324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA WIMBERLY F.N.P

Provider Business Mailing Address
First Line	:	3100 SCHOFIELD ROAD, BLGD 1178
Second Line	:	FORT SAM HOUSTON ADOLESCENT CLINIC MEDICINE CLINIC
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-6400
Country	:	US
Telephone Number	:	210-916-3160
Fax Number	:	210-861-2270

Provider Business Practice Location Address
First Line	:	3100 SCHOFIELD RD
Second Line	:	BLGD 1178
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7577
Country	:	US
Telephone Number	:	210-916-3160
Fax Number	:	210-861-2270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	09/22/2011

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