Provider Demographics
NPI:1588658728
Name:SIMMONS, REBECCA LYNN (FNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ROUTE 1 BOX 52A
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:TX
Mailing Address - Zip Code:76936-2206
Mailing Address - Country:US
Mailing Address - Phone:325-853-3137
Mailing Address - Fax:
Practice Address - Street 1:301 HUDSPETH ST STE B
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-8004
Practice Address - Country:US
Practice Address - Phone:325-387-7911
Practice Address - Fax:325-387-7912
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525494207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX860N56OtherBCBS