Provider Demographics
NPI:1033550918
Name:SIMMONS, DEIRDRE KIVETT (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:KIVETT
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MEDICAL PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2300
Mailing Address - Country:US
Mailing Address - Phone:318-325-6078
Mailing Address - Fax:318-324-9694
Practice Address - Street 1:430 S VINE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4514
Practice Address - Country:US
Practice Address - Phone:318-283-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily