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NPI Code Detail

MEDICARE: SHANNON DIA MIMS APRN, FNP-C

MEDICARE: SHANNON DIA MIMS APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPN.24871SC
2363LF0000XFamily Nurse PractitionerAP123896TX

General Provider Information

NPI Number : 1316371578
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON DIA MIMS APRN, FNP-C
Provider Business Mailing Address
First Line : 213 BARTON OAK TRL
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-3697
Country : US
Telephone Number : 512-680-1360
Fax Number :
Provider Business Practice Location Address
First Line : 13284 POND SPRINGS RD STE 402
Second Line :
City : AUSTIN
State : TX
Zip : 78729-7182
Country : US
Telephone Number : 512-243-6929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2013
Last Update Date : 03/19/2026

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