Provider Demographics
NPI:1952642407
Name:SIMMONS, STEPHANIE L (RN, MSN, APRN,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN, MSN, APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NASH ST
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-3968
Mailing Address - Country:US
Mailing Address - Phone:318-302-3032
Mailing Address - Fax:
Practice Address - Street 1:1536 BORDELON RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322
Practice Address - Country:US
Practice Address - Phone:318-346-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX745648163W00000X
TXAP125558363LF0000X
LAAP06993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse