Provider Demographics
NPI:1164401147
Name:SIMMERS, SHERRIAL RENAY (DO)
Entity Type:Individual
Prefix:
First Name:SHERRIAL
Middle Name:RENAY
Last Name:SIMMERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 6 GREAT TEAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:1701 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:WV
Practice Address - Zip Code:25312
Practice Address - Country:US
Practice Address - Phone:304-414-4499
Practice Address - Fax:304-414-4498
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7398338OtherAETNA
WV001721068OtherMS BCBS
WV1840696000Medicaid
WV1840696000Medicaid
WV001721068OtherMS BCBS
WV4072191Medicare PIN
WV4072194Medicare PIN
WV7398338OtherAETNA
H59405Medicare UPIN