Healthcare Provider Details

I. General information

NPI: 1437938370
Provider Name (Legal Business Name): HEATHER SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 10/29/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S ELM ST
MOOREFIELD WV
26836-1228
US

IV. Provider business mailing address

116 S ELM ST
MOOREFIELD WV
26836-1228
US

V. Phone/Fax

Practice location:
  • Phone: 304-703-7550
  • Fax:
Mailing address:
  • Phone: 304-703-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2023-4057
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: