Provider Demographics
NPI:1508330549
Name:SIMMONS, JAMIE MICHELE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:MICHELE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:721 N CHIPMAN ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2143
Mailing Address - Country:US
Mailing Address - Phone:989-413-0423
Mailing Address - Fax:
Practice Address - Street 1:3515 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8014
Practice Address - Country:US
Practice Address - Phone:517-755-6888
Practice Address - Fax:517-657-7759
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily