Healthcare Provider Details

I. General information

NPI: 1134570211
Provider Name (Legal Business Name): ERYN SIMMONS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERYN FENNELLY DO

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

1035 PLACER ST
REDDING CA
96001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax:
Mailing address:
  • Phone: 530-921-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT017432
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number007952
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20546
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A20546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: