Provider Demographics
NPI:1659631158
Name:SHIMMIN, JEANIE R (PPC)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:R
Last Name:SHIMMIN
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 5TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6924
Mailing Address - Country:US
Mailing Address - Phone:308-221-5288
Mailing Address - Fax:308-221-5306
Practice Address - Street 1:521 E 5TH ST STE 4
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6924
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:308-221-5306
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional