Provider Demographics
NPI:1205596756
Name:SIMMONS JR, STANLEY WINFRED (RN)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:WINFRED
Last Name:SIMMONS JR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 4TH ST W APT D2
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9301
Mailing Address - Country:US
Mailing Address - Phone:256-328-4056
Mailing Address - Fax:
Practice Address - Street 1:426 4TH ST W APT D2
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9301
Practice Address - Country:US
Practice Address - Phone:256-328-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-189971163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult