Healthcare Provider Details

I. General information

NPI: 1114370418
Provider Name (Legal Business Name): LEE M SIMON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 HIGHWAY 431
SAINT AMANT LA
70774-3904
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-644-0005
  • Fax: 225-644-0085
Mailing address:
  • Phone: 225-644-0005
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08855
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08855
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: