Provider Demographics
NPI:1255767588
Name:SIMMONS, CHAD EDWARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:EDWARD
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:600 CHRISTOPHER LN
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-1464
Mailing Address - Country:US
Mailing Address - Phone:985-981-6472
Mailing Address - Fax:
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:985-981-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant