Healthcare Provider Details

I. General information

NPI: 1205832920
Provider Name (Legal Business Name): JAN ALLISON SIMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 04/27/2006

III. Provider practice location address

1445 US HIGHWAY 51 BYP E
DYERSBURG TN
38024-2127
US

IV. Provider business mailing address

1445 US HIGHWAY 51 BYP E
DYERSBURG TN
38024-2127
US

V. Phone/Fax

Practice location:
  • Phone: 731-286-1900
  • Fax: 731-286-1939
Mailing address:
  • Phone: 731-286-1900
  • Fax: 731-286-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5639
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: