Provider Demographics
NPI:1639566623
Name:SIMMONS, EVELYN F
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:F
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RAPP HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8340
Mailing Address - Country:US
Mailing Address - Phone:740-222-8253
Mailing Address - Fax:
Practice Address - Street 1:29 RAPP HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8340
Practice Address - Country:US
Practice Address - Phone:740-222-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH776999Medicaid