Provider Demographics
NPI:1225508096
Name:SIMMONS, BRIAN LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
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 1:3943 E PONY EXPRESS PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5543
Mailing Address - Country:US
Mailing Address - Phone:801-789-5566
Mailing Address - Fax:081-642-2942
Practice Address - Street 1:3943 E PONY EXPRESS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5543
Practice Address - Country:US
Practice Address - Phone:801-789-5566
Practice Address - Fax:801-642-2942
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9136475-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner