Healthcare Provider Details

I. General information

NPI: 1154792810
Provider Name (Legal Business Name): FAWN ZIMMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BISMARK ST STE A
CONCORDIA MO
64020-8101
US

IV. Provider business mailing address

819 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 877-344-3572
  • Fax: 866-228-4492
Mailing address:
  • Phone: 816-330-6426
  • Fax: 660-259-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8647
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015035378
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: