Provider Demographics
NPI:1508118258
Name:SIMMONS, LAURIE CRNKOVIC (NP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:CRNKOVIC
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:CRNKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 221
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6800
Mailing Address - Country:US
Mailing Address - Phone:318-681-5240
Mailing Address - Fax:318-681-5241
Practice Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 221
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6800
Practice Address - Country:US
Practice Address - Phone:318-681-5240
Practice Address - Fax:318-681-5241
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082310363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care