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Individual
DR. KELLY L WIMBERLY
Active
Individual
DR. KELLY L WIMBERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J3002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH1426
MEDICARE RR GROUP NUMBER
TX
01
—
P00474586
MEDICARE RR PIN
TX
Enumeration date
07/19/2006
Last updated
09/20/2011
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