Provider Demographics
NPI:1205224482
Name:SIMON, ALLIE S (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:S
Last Name:SIMON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ALEYAMMA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 SPRINGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-5201
Mailing Address - Country:US
Mailing Address - Phone:405-419-9800
Mailing Address - Fax:
Practice Address - Street 1:1901 SPRINGLAKE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-5201
Practice Address - Country:US
Practice Address - Phone:405-419-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily