Provider Demographics
NPI:1679165716
Name:WIMBERLY, YONISHA LEIGH (RN)
Entity type:Individual
Prefix:MRS
First Name:YONISHA
Middle Name:LEIGH
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2344
Mailing Address - Country:US
Mailing Address - Phone:706-922-0600
Mailing Address - Fax:706-922-0603
Practice Address - Street 1:2604 PEACH ORCHARD RD STE 200
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2406
Practice Address - Country:US
Practice Address - Phone:706-922-0600
Practice Address - Fax:706-922-0603
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN231948163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty