Provider Demographics
NPI:1023470465
Name:SIMON, JADE ERICA (FNP-BC)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:ERICA
Last Name:SIMON
Suffix:
Gender:F
Credentials:FNP-BC
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 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-226-3186
Mailing Address - Fax:
Practice Address - Street 1:80 HUMPHREYS CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2361
Practice Address - Country:US
Practice Address - Phone:901-226-4280
Practice Address - Fax:901-226-4282
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS161337363LF0000X
ARA005652363LF0000X
TN161337363LF0000X
MS906984363LF0000X
TN20999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily