MEDICARE: BROOKE SIMMONS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	37002950A	IN

General Provider Information

NPI Number	:	1780148585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE SIMMONS RD

Provider Business Mailing Address
First Line	:	2103 CALDWELL PL
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-4438
Country	:	US
Telephone Number	:	240-751-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 WASHINGTON ST STE 9
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6790
Country	:	US
Telephone Number	:	240-751-7737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	05/21/2025

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Directions to “ BROOKE SIMMONS RD” Practice Location

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