Provider Demographics
NPI:1578698445
Name:WIMBERLY, BRANDEE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:BRANDEE
Middle Name:DENISE
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2469
Mailing Address - Country:US
Mailing Address - Phone:502-852-8500
Mailing Address - Fax:502-852-8556
Practice Address - Street 1:230 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2008
Practice Address - Country:US
Practice Address - Phone:502-629-8901
Practice Address - Fax:502-852-8556
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200892350Medicaid
KY7100010440Medicaid
KYK057070Medicare PIN