Provider Demographics
NPI:1770701054
Name:SIMME, BERNADETTE SUSANNE (MSN, APRN, BC)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:SUSANNE
Last Name:SIMME
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100-G100 LOGGER COURT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8512
Mailing Address - Country:US
Mailing Address - Phone:919-796-5771
Mailing Address - Fax:919-596-3458
Practice Address - Street 1:1100 LOGGER CT STE G100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8512
Practice Address - Country:US
Practice Address - Phone:919-796-5771
Practice Address - Fax:919-596-3458
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0352419364SP0808X, 364SP0809X
NC0352419-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004016Medicaid
NC87726OtherUBH
NC16412OtherUBH
NC130AYOtherBCBS
NC2802709Medicare ID - Type UnspecifiedMEDICARE