Provider Demographics
NPI:1316083579
Name:SIMMONS, JAMIE E (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:E
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 72605
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:804-379-1088
Practice Address - Street 1:1316 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2604
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001075363A00000X
VA0110003297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant