Basic Information
Provider Information
NPI: 1730844747
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIMMONS
FirstName: LYNDSI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1510
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477061510
CountryCode: US
TelephoneNumber: 8124506815
FaxNumber: 8124506822
Practice Location
Address1: 4506 1ST AVE
Address2:  
City: EVANSVILLE
State: IN
PostalCode: 477103624
CountryCode: US
TelephoneNumber: 8124286161
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/04/2021
LastUpdateDate: 11/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X3017164KYN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000X28216543AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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