Healthcare Provider Details

I. General information

NPI: 1912372798
Provider Name (Legal Business Name): JULIE SIMMONS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BROAD AVE STE 330
GULFPORT MS
39501-2464
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1234
  • Fax: 228-865-3038
Mailing address:
  • Phone: 601-261-1700
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number901460
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: