Provider Demographics
NPI:1912372798
Name:SIMMONS, JULIE (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-1700
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:301 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7233
Practice Address - Country:US
Practice Address - Phone:601-261-1700
Practice Address - Fax:601-288-8290
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07834351Medicaid