MEDICARE: JAIMY JOHN KARIMPANAMANNIL

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
1	363LF0000X	Family Nurse Practitioner	AP142611	TX

General Provider Information

NPI Number	:	1427606888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMY JOHN KARIMPANAMANNIL

Provider Business Mailing Address
First Line	:	2610 PEAR TREE LN
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-5631
Country	:	US
Telephone Number	:	817-863-1253
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3737
Country	:	US
Telephone Number	:	214-954-7389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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