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NPI Code Detail

MEDICARE: RAMON S JIMERSON

MEDICARE: RAMON S JIMERSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1538715545
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAMON S JIMERSON
Provider Business Mailing Address
First Line : 11401 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2349
Country : US
Telephone Number : 217-206-5160
Fax Number :
Provider Business Practice Location Address
First Line : 11401 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2349
Country : US
Telephone Number : 217-206-5160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2019
Last Update Date : 08/15/2019

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