Provider Demographics
NPI:1174616080
Name:SIMMONS, MORGAN WYATT (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:WYATT
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2354
Mailing Address - Country:US
Mailing Address - Phone:318-323-2244
Mailing Address - Fax:318-387-9595
Practice Address - Street 1:3408 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2354
Practice Address - Country:US
Practice Address - Phone:318-323-2244
Practice Address - Fax:318-387-9595
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN065733/AP03678363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1104248Medicaid
LA5CP72Medicare PIN