Provider Demographics
NPI:1942440755
Name:SIMMONS, SHANNON K (CRNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FRANKLIN ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4310
Mailing Address - Country:US
Mailing Address - Phone:256-533-7676
Mailing Address - Fax:256-533-3171
Practice Address - Street 1:810 FRANKLIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4310
Practice Address - Country:US
Practice Address - Phone:256-533-7676
Practice Address - Fax:256-533-3171
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner