Provider Demographics
NPI:1891821674
Name:SIMS, LARRY (PA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4511
Mailing Address - Country:US
Mailing Address - Phone:865-633-9469
Mailing Address - Fax:865-633-9474
Practice Address - Street 1:900 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4511
Practice Address - Country:US
Practice Address - Phone:865-633-9469
Practice Address - Fax:865-633-9474
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1298363A00000X
TN1707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL1298OtherSC LICENSE
FLPA9104089OtherPA MEDICAL LICENSE
SCTL1298OtherSC LICENSE