Provider Demographics
NPI:1346586112
Name:JIMENEZ, JENNIFER SUE (DNP, FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 W 1000 S
Mailing Address - Street 2:
Mailing Address - City:UNION MILLS
Mailing Address - State:IN
Mailing Address - Zip Code:46382-9514
Mailing Address - Country:US
Mailing Address - Phone:219-393-8894
Mailing Address - Fax:
Practice Address - Street 1:5247 W 1000 S
Practice Address - Street 2:
Practice Address - City:UNION MILLS
Practice Address - State:IN
Practice Address - Zip Code:46382-9514
Practice Address - Country:US
Practice Address - Phone:219-393-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147457A163W00000X
IN71004408A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201189950Medicaid
IN151913Medicare Oscar/Certification
IN151914Medicare Oscar/Certification