MEDICARE: KASSIE J SIMMONS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	267347	NC
2	363L00000X	Nurse Practitioner	5012971	NC
3	363LP2300X	Primary Care Nurse Practitioner	5012971	NC
4	363LF0000X	Family Nurse Practitioner	5012971	NC

General Provider Information

NPI Number	:	1013542315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIE J SIMMONS FNP-C

Provider Business Mailing Address
First Line	:	4172 OLD US HIGHWAY 74
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-7092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E 7TH AVE
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-1402
Country	:	US
Telephone Number	:	910-654-3143
Fax Number	:	910-654-4144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	04/01/2026

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