Provider Demographics
NPI:1578948881
Name:SIMMONS, ANGELA RIGDON (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RIGDON
Last Name:SIMMONS
Suffix:
Gender:F
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 1:117 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6690
Mailing Address - Country:US
Mailing Address - Phone:800-577-2570
Mailing Address - Fax:586-992-2830
Practice Address - Street 1:369 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3405
Practice Address - Country:US
Practice Address - Phone:864-255-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2283PAMedicaid
SCSC68537111Medicare PIN