Provider Demographics
NPI:1134686579
Name:JIMENEZ, ANA (A-GNP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 W CENTRAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-2100
Mailing Address - Country:US
Mailing Address - Phone:316-214-4919
Mailing Address - Fax:
Practice Address - Street 1:8821 W CENTRAL PARK CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-2100
Practice Address - Country:US
Practice Address - Phone:316-214-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS537892121363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology