Provider Demographics
NPI:1831523620
Name:SIMMONS, ALYSSA LOTT (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LOTT
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KATHRYN
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762-0900
Mailing Address - Country:US
Mailing Address - Phone:662-741-2151
Mailing Address - Fax:662-741-2700
Practice Address - Street 1:702 MARTIN LUTHER KING ST
Practice Address - Street 2:
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762-9314
Practice Address - Country:US
Practice Address - Phone:662-741-2151
Practice Address - Fax:662-741-2700
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR886545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily