Basic Information
| Provider Information | |||||||||
| NPI: | 1538198999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIMMER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | C.R.N.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 CREEKPORT DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427282120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703846139 | ||||||||
| FaxNumber: | 2703849061 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 N RACE ST | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706514444 | ||||||||
| FaxNumber: | 7026514234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3001277 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.