Provider Demographics
NPI:1790867158
Name:SIMMONS, MICHELLE SESSOMS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SESSOMS
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 EDMOND MATTHIS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-7355
Mailing Address - Country:US
Mailing Address - Phone:910-592-3907
Mailing Address - Fax:
Practice Address - Street 1:360 COUNTY COMPLEX ROAD
Practice Address - Street 2:(SAMPSON COUNTY HEALTH DEPARTMENT)
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-592-1131
Practice Address - Fax:910-592-4724
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63685363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP55684Medicare UPIN