Provider Demographics
NPI:1568878296
Name:WIMBERLEY, VIRGINIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:WIMBERLEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20902 KRANSBURG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-3584
Mailing Address - Country:US
Mailing Address - Phone:713-724-5620
Mailing Address - Fax:
Practice Address - Street 1:11445 COMPAQ CENTER WEST DR
Practice Address - Street 2:CCA5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1433
Practice Address - Country:US
Practice Address - Phone:713-724-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 82285133V00000X
TN2364133V00000X
1012437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered