Provider Demographics
NPI:1245412667
Name:SIMMONS, JOHN JR (LPN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIMMONS
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 LINSLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-3230
Mailing Address - Country:US
Mailing Address - Phone:843-768-5539
Mailing Address - Fax:843-225-6717
Practice Address - Street 1:7702 LINSLEY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-3230
Practice Address - Country:US
Practice Address - Phone:843-768-5539
Practice Address - Fax:843-225-6717
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR38138164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse