Basic Information
| Provider Information | |||||||||
| NPI: | 1053730390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIMBERLY-GIBSON | ||||||||
| FirstName: | FELECIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Practice Location | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN.240900 | OH | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | COA 15849-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | 15849 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | RN-240900 | 01 | OH | LICENSE | OTHER |