Provider Demographics
NPI:1144462557
Name:SIMMONS, WHITNEY R (PA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:R
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-7094
Mailing Address - Fax:540-564-7171
Practice Address - Street 1:13892 TIMBER WAY
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-3332
Practice Address - Country:US
Practice Address - Phone:540-901-0800
Practice Address - Fax:757-578-8547
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002988363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002988OtherPA LICENSE
VA01942W95Medicare PIN