Healthcare Provider Details

I. General information

NPI: 1326767963
Provider Name (Legal Business Name): MRS. ASHLEY NOELLE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NOELLE SIMMONS AGACNP

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 PHYSICIANS DR
CHARLESTON SC
29414-5746
US

IV. Provider business mailing address

PO BOX 1022
MOUNT PLEASANT SC
29465-1022
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-0499
  • Fax: 843-573-2463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPN.26479
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberAPN.26479
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: