Provider Demographics
NPI:1285447771
Name:SIMMONS, NICOLE MARIE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MICHELLE RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:METZ
Mailing Address - State:WV
Mailing Address - Zip Code:26585-7053
Mailing Address - Country:US
Mailing Address - Phone:304-986-1970
Mailing Address - Fax:
Practice Address - Street 1:21 MICHELLE RIGGS RD
Practice Address - Street 2:
Practice Address - City:METZ
Practice Address - State:WV
Practice Address - Zip Code:26585-7053
Practice Address - Country:US
Practice Address - Phone:304-986-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant