Individual
MARY REBEKAH JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6034
(423) 388-9961
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
246367
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
36821
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912684028
—
VA
05
—
Q098155
—
TN
Enumeration date
06/29/2023
Last updated
04/28/2026
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