Provider Demographics
NPI:1659831725
Name:JIMENEZ, JOHNNY (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6392 W ASHCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-8185
Mailing Address - Country:US
Mailing Address - Phone:559-799-2412
Mailing Address - Fax:
Practice Address - Street 1:3501 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2150
Practice Address - Country:US
Practice Address - Phone:737-387-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95039845163W00000X
CA95011333363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse