Provider Demographics
NPI:1285872713
Name:SIMMERSON, JULIE S (FNP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:S
Last Name:SIMMERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6415 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4021
Mailing Address - Country:US
Mailing Address - Phone:540-265-5500
Mailing Address - Fax:540-265-5515
Practice Address - Street 1:6415 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-265-5500
Practice Address - Fax:540-265-5515
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285872713Medicaid
VACA3863Medicare PIN
VA018752C18Medicare PIN
VAC01118Medicare PIN
VAP00755202Medicare PIN