Provider Demographics
NPI:1053730390
Name:WIMBERLY-GIBSON, FELECIA (CNP)
Entity type:Individual
Prefix:
First Name:FELECIA
Middle Name:
Last Name:WIMBERLY-GIBSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3169
Mailing Address - Country:US
Mailing Address - Phone:440-886-3150
Mailing Address - Fax:440-886-1636
Practice Address - Street 1:5850 RIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3169
Practice Address - Country:US
Practice Address - Phone:440-886-3150
Practice Address - Fax:440-886-1636
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 15849-NP363LF0000X
OH15849363LA2200X
OHRN.240900163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN-240900OtherLICENSE