MEDICARE: MELISSA SIMMONS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71012510A	IN
2	163W00000X	Registered Nurse	28173339C	IN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3018959	KY

General Provider Information

NPI Number	:	1467100875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SIMMONS

Provider Business Mailing Address
First Line	:	2855 CHARLESTOWN RD STE 300
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2691
Country	:	US
Telephone Number	:	502-265-5866
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 CHARLESTOWN RD STE 300
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-2691
Country	:	US
Telephone Number	:	502-265-5866
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	12/09/2025

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Directions to “ MELISSA SIMMONS ” Practice Location

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