Provider Demographics
NPI:1255703922
Name:SIMS, MICHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4202
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7280
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:270-506-2843
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQZZ000000090336OtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER
CS2023900271OtherCARESOURCE PROVIDER ID NUMBER
IN300039597Medicaid
000001394037OtherANTHEM PROVIDER ID NUMBER
KY3009835OtherLICENSE NUMBER
KY7100387780Medicaid
286322OtherSIHO PROVIDER ID NUMBER
KY2241647OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
KYP02538343OtherRAILROAD MEDICARE