Provider Demographics
NPI:1851149314
Name:SIMMONS, NETHOPHAH N C (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:NETHOPHAH
Middle Name:N C
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-0424
Mailing Address - Country:US
Mailing Address - Phone:912-412-2105
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 424
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-0424
Practice Address - Country:US
Practice Address - Phone:912-412-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283007363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care