Provider Demographics
NPI:1205440393
Name:SIMMONS, SARA ELISABETH
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELISABETH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 744
Mailing Address - Street 2:
Mailing Address - City:SALT ROCK
Mailing Address - State:WV
Mailing Address - Zip Code:25559-9761
Mailing Address - Country:US
Mailing Address - Phone:304-360-9502
Mailing Address - Fax:
Practice Address - Street 1:744 RT 2
Practice Address - Street 2:
Practice Address - City:SALT ROCK
Practice Address - State:WV
Practice Address - Zip Code:25559-9761
Practice Address - Country:US
Practice Address - Phone:304-360-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant