Healthcare Provider Details

I. General information

NPI: 1952642407
Provider Name (Legal Business Name): STEPHANIE L SIMMONS RN, MSN, APRN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 BORDELON RD
BUNKIE LA
71322
US

IV. Provider business mailing address

103 NASH ST
WINNFIELD LA
71483-3968
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-6657
  • Fax:
Mailing address:
  • Phone: 318-302-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745648
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125558
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06993
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: