Healthcare Provider Details

I. General information

NPI: 1013682822
Provider Name (Legal Business Name): ASHLEY DANIELLE SIMMONS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BENBOW RD
GREENSBORO NC
27477-4556
US

IV. Provider business mailing address

128 FORESTLAWN DR
DANVILLE VA
24540-4556
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-7880
  • Fax:
Mailing address:
  • Phone: 434-429-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024182378
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5015701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: