Provider Demographics
NPI:1417773011
Name:JIMENEZ JIMENEZ, EDSON MANUEL (FNP-C)
Entity type:Individual
Prefix:MR
First Name:EDSON
Middle Name:MANUEL
Last Name:JIMENEZ JIMENEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2623
Mailing Address - Country:US
Mailing Address - Phone:828-723-5008
Mailing Address - Fax:
Practice Address - Street 1:6336 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7141
Practice Address - Country:US
Practice Address - Phone:828-430-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09240300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner