MEDICARE: MRS. DESIREE SIMS PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022000274	WI
2	363L00000X	Nurse Practitioner	13415	WI
3	163W00000X	Registered Nurse	637144	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2022000274	OTHER	WI	ANCC PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285941740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESIREE SIMS PMHNP

Provider Business Mailing Address
First Line	:	8303 W NORTH AVE APT 4
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1666
Country	:	US
Telephone Number	:	414-731-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 W CENTER ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2159
Country	:	US
Telephone Number	:	414-444-8670
Fax Number	:	414-444-8678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/26/2024

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