Individual provider Active NPI

Skylar Brooke Wimberly

  • Medical Physician Assistant
  • Elkland, MO
National Provider Identifier
1477313567
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
11441 Issued in AZ
Practice address
25 Country Ridge LN
Elkland, MO 65644-7304
Phone
(417) 733-3208
NPI assigned
Mar 19, 2024
Last updated
Jun 3, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 11441 AZ Primary

Addresses

Primary practice location

25 Country Ridge LN
Elkland, MO 65644-7304

Mailing address

25 Country Ridge LN
Elkland, MO 65644-7304
Phone (417) 733-3208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20260216000344 AZ Practitioner - Physician Assistant 0840639332 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America- Arizona, PCGroup PAC ID 1850541970, 89 clinicians

Practice addresses (Care Compare)

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone (480) 412-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
11441AZMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-Arizona, PC CurrentSince Jan 29, 2026 Accepting new patients
Cox-Monett Hospital, Inc. Current Accepting new patients
Cep America - Arizona PC CurrentSince Jan 29, 2026 Accepting new patients
Cox-Monett Hospital, Inc. CurrentSince Apr 22, 2024 Accepting new patients
Skaggs Community Hospital Association Past Accepting new patients

Locations

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

1000 E US Highway 60
Monett, MO 65708
Phone (417) 354-1269

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1477313567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 COUNTRY RIDGE LN",
            "city": "ELKLAND",
            "state": "MO",
            "postal_code": "656447304",
            "telephone_number": "417-733-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COUNTRY RIDGE LN",
            "city": "ELKLAND",
            "state": "MO",
            "postal_code": "656447304",
            "telephone_number": "417-733-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMBERLY",
        "first_name": "SKYLAR",
        "middle_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "11441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkland, MO

Sources for this page

Verify at the official NPI Registry.