Provider Demographics
NPI:1487628376
Name:SIMS, TOMMY L (PA-C)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:L
Last Name:SIMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 MERRIFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2125
Mailing Address - Country:US
Mailing Address - Phone:727-482-0673
Mailing Address - Fax:
Practice Address - Street 1:550 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2231
Practice Address - Country:US
Practice Address - Phone:524-513-4112
Practice Address - Fax:524-513-4232
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101447363A00000X
NC0010-10229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292352100OtherMEDICAID
FL9677425OtherAETNA (FMSG)
FLY06TWOtherBCBS
FL017798600Medicaid
FL1065775OtherCAREPLUS (BOA)
FL7171751OtherAETNA
FLE4853XMedicare PIN
FLY06TWOtherBCBS
FLP81256Medicare UPIN