Provider Demographics
NPI:1508633769
Name:WIMBERLY, ALKERIA DEJANAE
Entity Type:Individual
Prefix:
First Name:ALKERIA
Middle Name:DEJANAE
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38543 N 86TH ST APT 34
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476-1632
Mailing Address - Country:US
Mailing Address - Phone:561-879-7850
Mailing Address - Fax:
Practice Address - Street 1:38543 N 86TH ST APT 34
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1632
Practice Address - Country:US
Practice Address - Phone:561-879-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB819007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst