Individual
MS. SHANEKA LATRISHA SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5706
(601) 984-5733
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5706
(601) 984-5733
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R879973
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03400807
—
MS
Enumeration date
07/02/2012
Last updated
11/30/2016
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