Provider Demographics
NPI:1891012639
Name:SIMMERMON, JAMES ERIC (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:SIMMERMON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3251
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-3251
Mailing Address - Country:US
Mailing Address - Phone:901-487-0000
Mailing Address - Fax:
Practice Address - Street 1:1985 BERRY HOLLOW CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-8532
Practice Address - Country:US
Practice Address - Phone:901-487-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN148845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse