MEDICARE: MRS. FAWN ZIMMER FNP

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	363LF0000X	Family Nurse Practitioner	AP8647	AZ
2	363LF0000X	Family Nurse Practitioner	2015035378	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154792810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FAWN ZIMMER FNP

Provider Business Mailing Address
First Line	:	819 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	816-330-6426
Fax Number	:	660-259-2440

Provider Business Practice Location Address
First Line	:	206 N BISMARK ST STE A
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-8101
Country	:	US
Telephone Number	:	877-344-3572
Fax Number	:	866-228-4492

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

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	05/16/2023

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