Provider Demographics
NPI:1457534273
Name:SIMMONS, NUTISHA LACOLE (CST)
Entity Type:Individual
Prefix:MRS
First Name:NUTISHA
Middle Name:LACOLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4594 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-6502
Mailing Address - Country:US
Mailing Address - Phone:318-949-3336
Mailing Address - Fax:
Practice Address - Street 1:4594 PINE CREST DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-6502
Practice Address - Country:US
Practice Address - Phone:318-949-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist