Provider Demographics
NPI:1659837110
Name:SIMMONS, JONATHAN TODD (RN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TODD
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 LORI CICLE
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641
Mailing Address - Country:US
Mailing Address - Phone:423-329-4108
Mailing Address - Fax:
Practice Address - Street 1:144 NASCAR BOULAVARD
Practice Address - Street 2:
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618
Practice Address - Country:US
Practice Address - Phone:423-742-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225727163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight