Provider Demographics
NPI:1760867543
Name:SIMMONS, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
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 1:1860 WILMA RUDOLPH BLVD
Mailing Address - Street 2:STE 103-B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6750
Mailing Address - Country:US
Mailing Address - Phone:931-920-8425
Mailing Address - Fax:931-378-7016
Practice Address - Street 1:1860 WILMA RUDOLPH BLVD
Practice Address - Street 2:STE 103-B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6750
Practice Address - Country:US
Practice Address - Phone:931-920-8425
Practice Address - Fax:931-378-7016
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000016299251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health