Provider Demographics
NPI:1467024745
Name:MIMS, CHARMAISE LYNETTE (LVN)
Entity Type:Individual
Prefix:
First Name:CHARMAISE
Middle Name:LYNETTE
Last Name:MIMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 BIGNER RD
Mailing Address - Street 2:6380BIGNER RD
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703
Mailing Address - Country:US
Mailing Address - Phone:409-351-0396
Mailing Address - Fax:
Practice Address - Street 1:6380 BIGNER ROAD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708
Practice Address - Country:US
Practice Address - Phone:409-351-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse