Provider Demographics
NPI:1679582191
Name:SIMMONS, CARLA GAIL (PA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:GAIL
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:GAIL
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-739-4175
Practice Address - Fax:214-987-4161
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193112302Medicaid
TX193112301Medicaid
TX193112304Medicaid
TX8J9524Medicare PIN
TX193112301Medicaid
TX8J9522Medicare PIN
TX8K7541Medicare UPIN
TXQ57219Medicare UPIN
TXTXB123427Medicare PIN