Heidi E Wimberly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA200094RX Issued in LA

Practice address

2600 Kings Hwy
Department of Radiation Oncology
Shreveport, LA 71103-3950

Phone

(318) 212-4639

Fax

(318) 212-8305

NPI assigned

Oct 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294876800000",
    "number": "1083797245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "DEPARTMENT OF RADIATION ONCOLOGY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033950",
            "telephone_number": "318-212-4639",
            "fax_number": "318-212-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "DEPARTMENT OF RADIATION ONCOLOGY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033950",
            "telephone_number": "318-212-4639",
            "fax_number": "318-212-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLY",
        "first_name": "HEIDI",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2011-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA200094RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1706566",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.