Provider Demographics
NPI:1669776860
Name:SIMMONS, ARIC WADE (APN)
Entity type:Individual
Prefix:
First Name:ARIC
Middle Name:WADE
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CORRECTIONS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-8008
Mailing Address - Country:US
Mailing Address - Phone:870-523-3808
Mailing Address - Fax:870-523-8604
Practice Address - Street 1:300 CORRECTIONS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-8008
Practice Address - Country:US
Practice Address - Phone:870-523-3808
Practice Address - Fax:870-523-8604
Is Sole Proprietor?:No
Enumeration Date:2011-01-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily