Healthcare Provider Details

I. General information

NPI: 1538099403
Provider Name (Legal Business Name): TRACY ANN SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 W COMMERCIAL ST
LYONS KS
67554-3900
US

IV. Provider business mailing address

1432 W COMMERCIAL ST
LYONS KS
67554-3900
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-2171
  • Fax: 620-257-7856
Mailing address:
  • Phone: 620-257-2171
  • Fax: 620-257-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number13-162596-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: