Dueward Shane Wimberly, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1111892 Issued in TX

Practice address

8535 Tom Slick
San Antonio, TX 78229-3367

Phone

(210) 582-6440

NPI assigned

Mar 8, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southwest Psychiatric Physicians

  • Child & Adolescent Psychiatry Physician
  • San Antonio, TX
  • NPI 1639286370
  Medicare reassignment

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1235839135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8535 TOM SLICK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293367",
            "telephone_number": "210-582-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8535 TOM SLICK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293367",
            "telephone_number": "210-582-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLY",
        "first_name": "DUEWARD",
        "middle_name": "SHANE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-08",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1111892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Robert Wilson, M.D.
• Yolanda Louise Wilson, RRT
• Zacchaeus Emmanuel Wilson, LPC
• Parker Jakob Wilstead
• Eric Edwin Wiltz, PHYSICIAN ASSISTANT
• Karen L Wimmer
• Jennifer D Wimpee, RD
• Shwe Yee Win, M.D.
• Jerald Winakur, MD
• Christopher Jason Winckler

• Psychiatric/Mental Health Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.