Provider Demographics
NPI:1437685880
Name:WIMBERLEY WELLNESS PLLC
Entity Type:Organization
Organization Name:WIMBERLEY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE HOYOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:806-848-4570
Mailing Address - Street 1:PO BOX 94534
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-4534
Mailing Address - Country:US
Mailing Address - Phone:806-848-4570
Mailing Address - Fax:
Practice Address - Street 1:14100 RANCH ROAD 12
Practice Address - Street 2:UNIT 900
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5354
Practice Address - Country:US
Practice Address - Phone:512-842-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty