# DR. SHANNON R. JIMENEZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1568552628
- **Gender:** F
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9900553 | IA | — |
| 207Q00000X | Family Medicine Physician | 9900553 | NC | — |
| 207Q00000X | Family Medicine Physician | S4847 | TX | Yes |

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 03/09/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0150C | BLUE CROSS GROUP \# | NC |
| 01 | — | 1215K | BLUE CROSS INDIVIDUAL | NC |
| 05 | — | 790150C | — | NC |
| 05 | — | 891215K | — | NC |