Provider Demographics
NPI:1588203590
Name:SIMMONS, AMYLENA (RN)
Entity Type:Individual
Prefix:
First Name:AMYLENA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 TATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-8633
Mailing Address - Country:US
Mailing Address - Phone:870-373-1853
Mailing Address - Fax:870-368-5032
Practice Address - Street 1:54 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8633
Practice Address - Country:US
Practice Address - Phone:870-373-1853
Practice Address - Fax:870-368-5032
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse