Healthcare Provider Details

I. General information

NPI: 1780062372
Provider Name (Legal Business Name): JASON SIMMONS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 10/30/2026
Certification Date: 10/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8321 MARYLAND AVE
CLAYTON MO
63105-3644
US

IV. Provider business mailing address

8321 MARYLAND AVE
CLAYTON MO
63105-3644
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-8010
  • Fax:
Mailing address:
  • Phone: 314-626-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026032377
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: