Provider Demographics
NPI:1528754868
Name:JIMENEZ, KATHYA ANAIS (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHYA
Middle Name:ANAIS
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N WILMOT RD STE 151
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2701
Mailing Address - Country:US
Mailing Address - Phone:480-415-0912
Mailing Address - Fax:
Practice Address - Street 1:603 N WILMOT RD STE 151
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2701
Practice Address - Country:US
Practice Address - Phone:520-420-2560
Practice Address - Fax:520-420-2562
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner