Provider Demographics
NPI:1013173707
Name:SIMMONS, TANYA RENEE (RD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N TOTTEN CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-6380
Mailing Address - Country:US
Mailing Address - Phone:812-352-8440
Mailing Address - Fax:
Practice Address - Street 1:2202 N TOTTEN CIR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-6380
Practice Address - Country:US
Practice Address - Phone:812-352-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN836192133V00000X
IN3700100A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered