Provider Demographics
NPI:1952903577
Name:SIMMONS, JUDITH JEAN
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:JEAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:JEAN
Other - Last Name:CASTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 DAN TOWN RD
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-7415
Mailing Address - Country:US
Mailing Address - Phone:304-457-1345
Mailing Address - Fax:
Practice Address - Street 1:142 DAN TOWN RD
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-7415
Practice Address - Country:US
Practice Address - Phone:304-457-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant