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NPI Code Detail

MEDICARE: MS. BRIDGETT ELAINE SIMONS I PRSS

MEDICARE: MS. BRIDGETT ELAINE SIMONS I PRSS
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1538892021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRIDGETT ELAINE SIMONS I PRSS
Provider Business Mailing Address
First Line : 1303 WASHINGTON ST W
Second Line :
City : CHARLESTON
State : WV
Zip : 25302-1333
Country : US
Telephone Number : 304-202-1699
Fax Number :
Provider Business Practice Location Address
First Line : 1303 WASHINGTON ST W
Second Line :
City : CHARLESTON
State : WV
Zip : 25302-1333
Country : US
Telephone Number : 304-202-1699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2022
Last Update Date : 07/02/2022

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Directions to “ MS. BRIDGETT ELAINE SIMONS I PRSS” Practice Location

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