Healthcare Provider Details

I. General information

NPI: 1285941740
Provider Name (Legal Business Name): DESIREE SIMS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE SIMS NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/26/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 W CENTER ST
MILWAUKEE WI
53210-2159
US

IV. Provider business mailing address

8303 W NORTH AVE APT 4
WAUWATOSA WI
53213-1666
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-8670
  • Fax: 414-444-8678
Mailing address:
  • Phone: 414-731-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022000274
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13415
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number637144
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: