Provider Demographics
NPI:1508403296
Name:SIMON, NISSY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NISSY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19255 PARK ROW STE 203
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7310
Mailing Address - Country:US
Mailing Address - Phone:281-646-8450
Mailing Address - Fax:
Practice Address - Street 1:19255 PARK ROW STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7310
Practice Address - Country:US
Practice Address - Phone:281-646-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXID0301OtherMEDICARE
TXAP144177OtherTEXAS BON
TXAP144177OtherTEXAS BOARD OF NURSING