Keltin Jimmerson, CRNP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

1-162676 Issued in AL

Practice address

104 Medical Dr # 104
Dothan, AL 36303-6902

Phone

(334) 671-9447

Fax

(334) 836-0059

NPI assigned

Feb 24, 2022

Last updated

Apr 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wiregrass Clinic LLCGroup PAC ID 2860662491, 69 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Obstetrics & Gynecology of Dothan Inc

  dba Ladies First

  • Obstetrics & Gynecology Physician
  • Dothan, AL
  • NPI 1114021409
  Medicare reassignment NPD
• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Medicare reassignment NPD
• Wiregrass Clinic LLC

  • Neurological Surgery Physician
  • Dothan, AL
  • NPI 1558657890
  Care Compare group
• Tallahassee Memorial Healthcare Inc

  dba TMH Physician Partners

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1366293102
  NPD
• Allara Medical Group PA

  • Gynecology Physician
  • New York, NY
  • NPI 1700450558
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1730835190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 JONES RD",
            "city": "NEWTON",
            "state": "AL",
            "postal_code": "363528072",
            "telephone_number": "334-796-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MEDICAL DR # 104",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363036902",
            "telephone_number": "334-671-9447",
            "fax_number": "334-836-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMMERSON",
        "first_name": "KELTIN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-24",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "AL",
            "license": "1-162676",
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lynn Jensen
• Caela Jernigan
• Jessica Byrd White LLC
• Richard Henry Jester
• Robert Jerold Jewell, CRNA
• JL Scott Inc (Pharmaceutical Compounding Center of Dothan)
• Joe T Brown Memorial Hospice House
• John H Gordon DO LLC
• John J Flowers Jr DMD PC
• Gregory A Johns, MD

• Women's Health Nurse Practitioner in Dothan, AL
• Providers in Dothan, AL by specialty
• Women's Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.