Provider Demographics
NPI:1083903355
Name:SIMS, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 COMMERCIAL CENTER DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9492
Mailing Address - Country:US
Mailing Address - Phone:870-735-3015
Mailing Address - Fax:870-735-3018
Practice Address - Street 1:4001 COMMERCIAL CENTER DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9492
Practice Address - Country:US
Practice Address - Phone:870-735-3015
Practice Address - Fax:870-735-3018
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst