Provider Demographics
NPI:1841855160
Name:JIMENEZ, ASHLEY NICOLE (NP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 CENTENNIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-4013
Mailing Address - Country:US
Mailing Address - Phone:910-908-6257
Mailing Address - Fax:
Practice Address - Street 1:55 CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-4013
Practice Address - Country:US
Practice Address - Phone:910-908-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2024-01-04
Deactivation Date:2019-05-02
Deactivation Code:
Reactivation Date:2019-05-20
Provider Licenses
StateLicense IDTaxonomies
NC245896163W00000X
NC5011709363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse