Healthcare Provider Details

I. General information

NPI: 1659631158
Provider Name (Legal Business Name): JEANIE R SHIMMIN PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 5TH ST STE 4
NORTH PLATTE NE
69101-6924
US

IV. Provider business mailing address

521 E 5TH ST STE 4
NORTH PLATTE NE
69101-6924
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax: 308-221-5306
Mailing address:
  • Phone: 308-221-5288
  • Fax: 308-221-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1544
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: