Provider Demographics
NPI:1376044164
Name:SIMMS, JESSICA KELLY (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KELLY
Last Name:SIMMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KELLY
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3346
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:19415 DEERFIELD AVE STE 314
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8472
Practice Address - Country:US
Practice Address - Phone:703-723-7171
Practice Address - Fax:703-723-7176
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006087363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110006087OtherVIRGINIA LICENSE
VA1376044164Medicaid
VA30016148880002Medicaid