Provider Demographics
NPI:1073855433
Name:MIMS, LIBBY WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LIBBY
Middle Name:WILSON
Last Name:MIMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8921 GENTLEWIND WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4471
Mailing Address - Country:US
Mailing Address - Phone:205-410-1442
Mailing Address - Fax:
Practice Address - Street 1:411 E CHESTNUT ST STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-3440
Practice Address - Fax:502-588-3441
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY49331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics