Provider Demographics
NPI:1417513540
Name:SIMMONS, JOQUETTE S (CMA)
Entity Type:Individual
Prefix:
First Name:JOQUETTE
Middle Name:S
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:JOQUETTE
Other - Middle Name:S
Other - Last Name:RICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:166 DANZID DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-9283
Mailing Address - Country:US
Mailing Address - Phone:843-695-7452
Mailing Address - Fax:
Practice Address - Street 1:166 DANZID DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-9283
Practice Address - Country:US
Practice Address - Phone:843-695-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2398185251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health