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General NPI Number Information
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NPI Number | 1356038368
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Entity Type | Individual
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Provider Name | MRS. CASSEY DIANE SIMONS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 143 PARKERS RDG
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City | EL DORADO
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State | AR
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Zip | 71730-3988
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Country | US
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Telephone | 870-639-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 143 PARKERS RDG
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City | EL DORADO
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State | AR
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Zip | 71730-3988
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Country | US
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Telephone | 870-639-1117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 223526
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License Number State | AR
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