Provider Demographics
NPI:1265087308
Name:MEMMINGER, JIMMIE KEVIN (MS)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:KEVIN
Last Name:MEMMINGER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 CHAPMAN RD STE 105-2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5499
Mailing Address - Country:US
Mailing Address - Phone:302-345-5530
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5499
Practice Address - Country:US
Practice Address - Phone:302-345-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty