Provider Demographics
NPI:1376500660
Name:SIMMONS, JENNIFER SNEAD (RN, MSN, CPNP, CPON)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SNEAD
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN, MSN, CPNP, CPON
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SNEAD
Other - Last Name:COMPERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CPNP, CPON
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4085
Practice Address - Fax:336-716-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113484363LP0200X
NC300301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003709Medicaid
NC2592377Medicare PIN
NC7003709Medicaid