Provider Demographics
NPI:1679180699
Name:SIMMONS, WHITNEY MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MICHELLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MICHELLE
Other - Last Name:CALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14000 N PORTLAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4025
Mailing Address - Country:US
Mailing Address - Phone:405-548-4848
Mailing Address - Fax:833-470-1448
Practice Address - Street 1:14000 N PORTLAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4025
Practice Address - Country:US
Practice Address - Phone:405-548-4848
Practice Address - Fax:833-470-1448
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109792163W00000X
OK200705363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKSSNMedicaid