Provider Demographics
NPI:1124441571
Name:SIMS, TERESA MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:SIMS
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 1:2207 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2211
Mailing Address - Country:US
Mailing Address - Phone:662-241-7177
Mailing Address - Fax:662-241-7176
Practice Address - Street 1:2207 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2211
Practice Address - Country:US
Practice Address - Phone:662-251-3565
Practice Address - Fax:662-241-7176
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03200051Medicaid
MS03200051Medicaid