MEDICARE: MRS. JUDIETH DARLENE SIMS FNP-BC, CRNP

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	363LF0000X	Family Nurse Practitioner	1103330	AL

General Provider Information

NPI Number	:	1619423936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDIETH DARLENE SIMS FNP-BC, CRNP

Provider Business Mailing Address
First Line	:	858 COUNTY ROAD 426
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352-3711
Country	:	US
Telephone Number	:	334-714-6415
Fax Number	:	334-556-0049

Provider Business Practice Location Address
First Line	:	858 COUNTY ROAD 426
Second Line	:
City	:	NEWTON
State	:	AL
Zip	:	36352-3711
Country	:	US
Telephone Number	:	334-714-6415
Fax Number	:	334-556-0049

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

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	08/28/2016

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