Provider Demographics
NPI:1285941740
Name:SIMS, DESIREE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:8303 W NORTH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1666
Mailing Address - Country:US
Mailing Address - Phone:414-731-5862
Mailing Address - Fax:
Practice Address - Street 1:6200 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2159
Practice Address - Country:US
Practice Address - Phone:414-444-8670
Practice Address - Fax:414-444-8678
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2022000274363LP0808X
WI13415363L00000X
TX637144163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2022000274OtherANCC PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER
WI363L00000XMedicaid