Healthcare Provider Details

I. General information

NPI: 1477476968
Provider Name (Legal Business Name): MADDISON ERYKAH BRI-AN SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 15TH ST
WEST SACRAMENTO CA
95691-3737
US

IV. Provider business mailing address

2066 WYNDHAM WAY
LODI CA
95242-4807
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-2345
  • Fax:
Mailing address:
  • Phone: 209-684-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: