Provider Demographics
NPI:1336457266
Name:WIMBERLY, ERICA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:984-215-5588
Practice Address - Fax:919-570-6383
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-02470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant