Provider Demographics
NPI:1710027677
Name:SIMMONS, JULIA
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
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 1:515 KEISLER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7097
Mailing Address - Country:US
Mailing Address - Phone:919-757-6844
Mailing Address - Fax:919-230-2510
Practice Address - Street 1:515 KEISLER DR STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7097
Practice Address - Country:US
Practice Address - Phone:919-757-6844
Practice Address - Fax:191-230-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 332BN1400X
NC347385376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies