Healthcare Provider Details

I. General information

NPI: 1801712336
Provider Name (Legal Business Name): NICOLA ERICA SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E BENNETT ST APT A11
SPRINGFIELD MO
65804-1766
US

IV. Provider business mailing address

2020 E BENNETT ST APT A11
SPRINGFIELD MO
65804-1766
US

V. Phone/Fax

Practice location:
  • Phone: 712-202-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR049671
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: