Provider Demographics
NPI:1891203873
Name:WIMBISH, BRYAN (CRNP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:WIMBISH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 BROCKS GAP PKWY
Mailing Address - Street 2:STE 185
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 BROCKS GAP PKWY STE 185
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4078
Practice Address - Country:US
Practice Address - Phone:205-352-2911
Practice Address - Fax:205-352-2910
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily