MEDICARE: JESSICA NIMIE MA, EDS, PPS

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1386574358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NIMIE MA, EDS, PPS

Provider Business Mailing Address
First Line	:	4111 LAS VIRGENES RD
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22855 MULHOLLAND HWY
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-2099
Country	:	US
Telephone Number	:	818-222-7177
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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