Provider Demographics
NPI:1164822813
Name:SIMMONS, JOHN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 ISSAC ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-7613
Mailing Address - Country:US
Mailing Address - Phone:409-617-1354
Mailing Address - Fax:
Practice Address - Street 1:280 FARM RD 418
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656
Practice Address - Country:US
Practice Address - Phone:409-386-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily