Provider Demographics
NPI:1164644282
Name:SIMMONS, MARY ELAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELAINE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELAINE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 172881
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-2881
Mailing Address - Country:US
Mailing Address - Phone:817-561-5512
Mailing Address - Fax:817-920-7368
Practice Address - Street 1:6101 AUTUMN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5004
Practice Address - Country:US
Practice Address - Phone:817-561-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse