Healthcare Provider Details

I. General information

NPI: 1386554186
Provider Name (Legal Business Name): PATRICIA SIMMONS RODRIGUEZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 JOSHUA LN
WINSTON SALEM NC
27127-7603
US

IV. Provider business mailing address

2316 JOSHUA LN
WINSTON SALEM NC
27127-7603
US

V. Phone/Fax

Practice location:
  • Phone: 336-486-8085
  • Fax:
Mailing address:
  • Phone: 336-486-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number172220
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: