MEDICARE: KRISTAL LYN SIMMONS FNP

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	363LF0000X	Family Nurse Practitioner	AP1444805	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP144805	TX

General Provider Information

NPI Number	:	1871124107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTAL LYN SIMMONS FNP

Provider Business Mailing Address
First Line	:	805 N 17TH PL
Second Line	:
City	:	SLATON
State	:	TX
Zip	:	79364-3100
Country	:	US
Telephone Number	:	806-746-7519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 MARTIN LUTHER KING BLVD
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79403-5329
Country	:	US
Telephone Number	:	806-749-3800
Fax Number	:	806-749-3802

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	12/03/2021

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