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NPI Code Detail

MEDICARE: TATJANA MICHELE MIMES CPNP

MEDICARE: TATJANA MICHELE MIMES CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner1193553TX

General Provider Information

NPI Number : 1295376374
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATJANA MICHELE MIMES CPNP
Provider Business Mailing Address
First Line : 3975 I 49 S SERVICE RD STE 201
Second Line :
City : OPELOUSAS
State : LA
Zip : 70570-0775
Country : US
Telephone Number : 337-407-2795
Fax Number :
Provider Business Practice Location Address
First Line : 2813 SMITH RANCH RD
Second Line :
City : PEARLAND
State : TX
Zip : 77584-5254
Country : US
Telephone Number : 832-582-7146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2019
Last Update Date : 01/26/2026

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