Provider Demographics
NPI:1811468515
Name:WOMBLE, JOHN JEFFREY (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEFFREY
Last Name:WOMBLE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3534
Mailing Address - Country:US
Mailing Address - Phone:325-672-3252
Mailing Address - Fax:325-480-9400
Practice Address - Street 1:1441 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3534
Practice Address - Country:US
Practice Address - Phone:325-672-3252
Practice Address - Fax:325-480-9400
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily