Basic Information
| Provider Information | |||||||||
| NPI: | 1124064324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIMBERLY | ||||||||
| FirstName: | PATRICIA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 SCHOFIELD ROAD, BLGD 1178 | ||||||||
| Address2: | FORT SAM HOUSTON ADOLESCENT CLINIC MEDICINE CLINIC | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109163160 | ||||||||
| FaxNumber: | 2108612270 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 SCHOFIELD RD | ||||||||
| Address2: | BLGD 1178 | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782347577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109163160 | ||||||||
| FaxNumber: | 2108612270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2005003696-22 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.