Provider Demographics
NPI:1386678035
Name:SIMMONS, SHIRLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:MONONGALIA GENERAL HOSPITAL
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1615
Mailing Address - Country:US
Mailing Address - Phone:304-598-1200
Mailing Address - Fax:304-598-1457
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:MONONGALIA GENERAL HOSPITAL
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-1200
Practice Address - Fax:304-598-1457
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1043OtherPA-C LICENSE