Provider Demographics
NPI:1285792705
Name:SIMMS-ROBERSON, PRISCILLA MARIE (ADVANCE ADULT NURSE)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MARIE
Last Name:SIMMS-ROBERSON
Suffix:
Gender:F
Credentials:ADVANCE ADULT NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 GUNBARREL RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3905 HIXSON PIKE STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3569
Practice Address - Country:US
Practice Address - Phone:423-756-1506
Practice Address - Fax:423-756-1909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341183Medicare PIN
TNP00467509OtherRR MEDICARE PIN
TN3706633OtherMEDICARE LEGACY GROUP