Active NPI
Shellye Simmons, CNP
- Family Nurse Practitioner
- Muskogee, OK
National Provider Identifier
1295248581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 75190
- Practice address
- 350 S 40TH St
Muskogee, OK 74401-4915 - Phone
- (918) 683-0753
- Fax
- (918) 683-5677
- NPI assigned
- Nov 9, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | R0075190 | OK | |
| Family Nurse Practitioner | 363LF0000X | 75190 | OK | Primary |
Addresses
Primary practice location
350 S 40TH St
Muskogee, OK 74401-4915
Mailing address
350 S 40TH St
Muskogee, OK 74401-4915
Phone (918) 683-0753
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200746490A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0075190 | OK | MD | Critical Care Medicine Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515542400000",
"number": "1295248581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 S 40TH ST",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744014915",
"telephone_number": "918-683-0753",
"fax_number": "918-683-5677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 S 40TH ST",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744014915",
"telephone_number": "918-683-0753",
"fax_number": "918-683-5677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "SHELLYE",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-09",
"last_updated": "2018-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "OK",
"license": "R0075190",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OK",
"license": "75190",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200746490A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muskogee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.