Provider Demographics
NPI:1811653785
Name:SIMMONS, LACY JAYE (FNP)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:JAYE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:JAYE
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8384
Mailing Address - Fax:337-312-6707
Practice Address - Street 1:501 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3859
Practice Address - Country:US
Practice Address - Phone:337-436-3813
Practice Address - Fax:337-439-0214
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN147217363LF0000X
LA223145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily