Provider Demographics
NPI:1659100576
Name:SIMMONS, CHARLES (LPN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 WILKENBERG DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-5100
Mailing Address - Country:US
Mailing Address - Phone:713-828-6432
Mailing Address - Fax:
Practice Address - Street 1:11406 WILKENBERG DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-5100
Practice Address - Country:US
Practice Address - Phone:713-828-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse