Provider Demographics
NPI:1689603144
Name:SIMMONS, LEE A (PA-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:A
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 1:112 HOTEL RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3224
Mailing Address - Country:US
Mailing Address - Phone:865-689-4500
Mailing Address - Fax:865-689-7320
Practice Address - Street 1:112 HOTEL RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3224
Practice Address - Country:US
Practice Address - Phone:865-689-4500
Practice Address - Fax:865-689-7320
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001796363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I970672Medicare PIN
TN0677340001Medicare NSC