MEDICARE: MCKENZIE JIMENEZ

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	163WC0200X	Critical Care Medicine Registered Nurse	821192	NV

General Provider Information

NPI Number	:	1063354934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE JIMENEZ

Provider Business Mailing Address
First Line	:	8821 TETON VIEW RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8821 TETON VIEW RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5040
Country	:	US
Telephone Number	:	702-772-7487
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ MCKENZIE JIMENEZ ” Practice Location

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