Provider Demographics
NPI:1083709802
Name:SIMMONS, ANITA JOYCE (APN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:JOYCE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:APN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:
Practice Address - Street 1:606 W WILBUR MILLS AVE
Practice Address - Street 2:
Practice Address - City:KENSETT
Practice Address - State:AR
Practice Address - Zip Code:72082-9051
Practice Address - Country:US
Practice Address - Phone:501-742-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS01126 CNS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213493758Medicaid
AR501197YJG2Medicare PIN
AR57297Medicare UPIN