MEDICARE: KIZZIE JIMMERSON CNA, RCMA

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	376K00000X	Nurse's Aide	NA835949	TX

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	:	1184123663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIZZIE JIMMERSON CNA, RCMA

Provider Business Mailing Address
First Line	:	838 GREENS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-1417
Country	:	US
Telephone Number	:	281-570-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 GREENS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-1417
Country	:	US
Telephone Number	:	128-157-0844
Fax Number	:

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	02/09/2018

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