Provider Demographics
NPI:1649467697
Name:JIMENEZ, KRISTEN RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RAE
Last Name:JIMENEZ
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-0123
Mailing Address - Fax:612-625-6919
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-2663
Practice Address - Fax:612-626-2664
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2014-12-30
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Provider Licenses
StateLicense IDTaxonomies
WI2195-023363A00000X
MN10574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant