Provider Demographics
NPI:1265428635
Name:SIMMONS, DREW BRADLEY (NP)
Entity type:Individual
Prefix:MR
First Name:DREW
Middle Name:BRADLEY
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 EASTLAND DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8972
Mailing Address - Country:US
Mailing Address - Phone:208-733-5117
Mailing Address - Fax:208-733-5143
Practice Address - Street 1:1182 EASTLAND DR N
Practice Address - Street 2:SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8972
Practice Address - Country:US
Practice Address - Phone:208-733-5117
Practice Address - Fax:208-733-5143
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-444A363LF0000X
NVAPN00546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDS94474Medicare UPIN
ID1342584Medicare ID - Type UnspecifiedHAILEY OFFICE
NV38581Medicare ID - Type UnspecifiedELKO OFFICE
ID1342583Medicare ID - Type UnspecifiedBURLEY OFFICE
ID1342582Medicare ID - Type UnspecifiedTF OFFICE