HEIDI E WIMBERLY (NPI# 1083797245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083797245 |
| Entity Type | Individual |
| Full Name | HEIDI E WIMBERLY |
| Credential | PA-C |
| Practice Address |
2600 Kings Hwy Department of Radiation Oncology Shreveport LA 71103-3950 |
| Practice Telephone | 3182124639 |
| Practice Fax Number | 3182128305 |
| Mailing Telephone | 3182124639 |
| Mailing Fax Number | 3182128305 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-01-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA200094RX | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1706566 | 05 |
| Street Address |
2600 KINGS HWY DEPARTMENT OF RADIATION ONCOLOGY |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-3950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265439863 | Michael Leonard Durci | Radiology | 2600 Kings Hwy, Willis Knighton Cancer Center, Shreveport, LA 71103-3950 | 2005-06-28 |
| 1922478304 | Wk Radiation Oncology Services | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2015-09-29 |
| 1932578820 | Amanda Lyn Hayes | Nurse Practitioner | 2600 Kings Hwy, #420, Shreveport, LA 71103-3950 | 2015-09-21 |
| 1659767127 | Sergio Jaramillo | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2015-04-11 |
| 1457615395 | Chiachien Jake Wang | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2012-06-26 |
| 1528330305 | Andrea Marie Moore | Clinical Nurse Specialist | 2600 Kings Hwy, Suite 340, Shreveport, LA 71103-3950 | 2012-02-08 |
| 1093006603 | Daniella Phuong-di Dang | Radiology | 2600 Kings Hwy, Shreveport, LA 71103-3950 | 2011-04-29 |
| 1548448442 | Robin Ann Lacour | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2008-02-04 |
| 1740493923 | Wk Gynecologic Oncology Clinic | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2007-05-07 |
| 1306062625 | Destin R. Black | Obstetrics & Gynecology | 2600 Kings Hwy, Suite 420, Shreveport, LA 71103-3950 | 2007-04-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790228013 | Brian Keith Fontenot | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2016-11-18 |
| 1831412626 | Christopher Micheal Magill | Physician Assistant | 2551 Greenwood Rd Ste 210, Shreveport, LA 71103-3985 | 2010-03-08 |
| 1851401426 | Teresa Bigler | Physician Assistant | 1606 Kings Hwy, Shreveport, LA 71103-4128 | 2006-08-30 |
| 1730118365 | Tina Faith Gentry | Physician Assistant | 7925 Youree Dr Suite 280b, Shreveport, LA 71105-5538 | 2006-07-03 |
| 1487616538 | David Stanley Staton | Physician Assistant | Overton Brooks Vamc, 510 East Stoner Ave, Shreveport, LA 71101 | 2006-04-04 |
| 1114924404 | Mary Mcferren | Physician Assistant | 1455 E Bert Kouns Industrial Loop # 200, Shreveport, LA 71105 | 2005-07-01 |
| 1487252029 | Melissa Raney | Physician Assistant | 2709 Mackey Ln, Shreveport, LA 71118-2556 | 2020-10-15 |
| 1629683230 | Amanda Renae Simmons | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-09-10 |
| 1700496312 | Caroline Leigh Harris | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2020-08-07 |
| 1811459449 | Lyndsey Pate Day | Physician Assistant | 1541 Kings Hwy, Shreveport, LA 71103-4228 | 2019-04-02 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
Please comment or provide details below to improve the information on HEIDI E WIMBERLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.