MEDICARE: EMILY K SIMONEAU PMHNP-BC, AGACNP-BC

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	363L00000X	Nurse Practitioner	5007575	NC
2	363LA2100X	Acute Care Nurse Practitioner	5007575	NC
3	363LG0600X	Gerontology Nurse Practitioner	5007575	NC
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5007575	NC

General Provider Information

NPI Number	:	1902292667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY K SIMONEAU PMHNP-BC, AGACNP-BC

Provider Business Mailing Address
First Line	:	8326 PINEVILLE MATTHEWS RD # 470173
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4752
Country	:	US
Telephone Number	:	980-355-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	8326 PINEVILLE MATTHEWS RD # 470173
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4752
Country	:	US
Telephone Number	:	980-355-9494
Fax Number	:

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

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	03/14/2026

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