Basic Information
| Provider Information | |||||||||
| NPI: | 1942440755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 FRANKLIN ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337676 | ||||||||
| FaxNumber: | 2565333171 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 FRANKLIN ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337676 | ||||||||
| FaxNumber: | 2565333171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-087017 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.