Healthcare Provider Details

I. General information

NPI: 1760753024
Provider Name (Legal Business Name): ANN SIMMONDS LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 4TH ST
WILMINGTON NC
28401-3450
US

IV. Provider business mailing address

501 VALLIE LN
WILMINGTON NC
28412-2724
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0270
  • Fax: 910-251-3450
Mailing address:
  • Phone: 910-599-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4111
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: