Provider Demographics
NPI:1992359475
Name:MIMS, PATRICIA ANN (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MIMS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SOUTHFORK LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-6039
Mailing Address - Country:US
Mailing Address - Phone:832-661-4201
Mailing Address - Fax:
Practice Address - Street 1:1206 SOUTHFORK LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-6039
Practice Address - Country:US
Practice Address - Phone:832-661-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily