Provider Demographics
NPI:1104519594
Name:SIMERLY, ALLISON MARIE (RN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:SIMERLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 NIGHT STALKER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-798-4744
Mailing Address - Fax:
Practice Address - Street 1:124 MEADOW LN
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-5207
Practice Address - Country:US
Practice Address - Phone:423-895-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12823182163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management