Healthcare Provider Details

I. General information

NPI: 1013811108
Provider Name (Legal Business Name): JESSIE KIMMELMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PARKWAY OFFICE CT STE 201
CARY NC
27518-7425
US

IV. Provider business mailing address

135 PARKWAY OFFICE CT STE 201
CARY NC
27518-7425
US

V. Phone/Fax

Practice location:
  • Phone: 919-476-1118
  • Fax:
Mailing address:
  • Phone: 919-476-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09260306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: