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General NPI Number Information
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NPI Number | 1316371578
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Entity Type | Individual
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Provider Name | SHANNON DIA MIMS APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 13625 RONALD W REAGAN BLVD BLDG 6
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City | CEDAR PARK
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State | TX
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Zip | 78613-2073
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Country | US
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Telephone | 512-336-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 213 BARTON OAK TRL
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City | GEORGETOWN
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State | TX
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Zip | 78628-3697
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Country | US
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Telephone | 512-680-1360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.24871
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP123896
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License Number State | TX
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