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General NPI Number Information
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NPI Number | 1083955868
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Entity Type | Individual
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Provider Name | KATHLEEN D JIMMIE APRN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 2045 DIXWELL AVE
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City | HAMDEN
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State | CT
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Zip | 06514-2405
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 29 MAPLE ST APT 304
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City | SEYMOUR
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State | CT
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Zip | 06483-3347
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Country | US
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Telephone | 225-573-1905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 005283
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License Number State | CT
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