Provider Demographics
NPI:1285620633
Name:SIMMONS, DEBRA H (RNC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:H
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:H
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1401 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4633
Mailing Address - Country:US
Mailing Address - Phone:662-226-4010
Mailing Address - Fax:662-226-4495
Practice Address - Street 1:1401 OAK ST
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4633
Practice Address - Country:US
Practice Address - Phone:662-226-4010
Practice Address - Fax:662-226-4495
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR728179364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116294Medicaid
MSP14485Medicare UPIN
MS500000752Medicare ID - Type Unspecified