Healthcare Provider Details

I. General information

NPI: 1467100875
Provider Name (Legal Business Name): MELISSA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CHARLESTOWN RD STE 300
NEW ALBANY IN
47150-2691
US

IV. Provider business mailing address

2855 CHARLESTOWN RD STE 300
NEW ALBANY IN
47150-2691
US

V. Phone/Fax

Practice location:
  • Phone: 502-265-5866
  • Fax:
Mailing address:
  • Phone: 502-265-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71012510A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28173339C
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3018959
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: