Provider Demographics
NPI:1336813195
Name:SIMMONS, SELENA PATRICK (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:PATRICK
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WHITEVILLE TOWN CTR
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4401
Mailing Address - Country:US
Mailing Address - Phone:910-212-6613
Mailing Address - Fax:910-320-8434
Practice Address - Street 1:5 WHITEVILLE TOWN CTR
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4401
Practice Address - Country:US
Practice Address - Phone:910-212-6613
Practice Address - Fax:910-320-8434
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily