Healthcare Provider Details

I. General information

NPI: 1669398236
Provider Name (Legal Business Name): CHARLES D SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

IV. Provider business mailing address

2204 6TH AVE APT C
PARKERSBURG WV
26101-5876
US

V. Phone/Fax

Practice location:
  • Phone: 304-679-3309
  • Fax:
Mailing address:
  • Phone: 681-537-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: