Provider Demographics
NPI:1346490612
Name:JIMERSON, CHEKESHA (BSN, RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:CHEKESHA
Middle Name:
Last Name:JIMERSON
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 W GAINSBOROUGH RD APT 202
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2479
Mailing Address - Country:US
Mailing Address - Phone:805-777-1612
Mailing Address - Fax:
Practice Address - Street 1:2125 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7329
Practice Address - Country:US
Practice Address - Phone:805-654-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696669171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator