Healthcare Provider Details

I. General information

NPI: 1912828187
Provider Name (Legal Business Name): TAMMY SIMONS MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 N COUNTY ROAD 18
MARIENTHAL KS
67863-6300
US

IV. Provider business mailing address

885 N COUNTY ROAD 18
MARIENTHAL KS
67863-6300
US

V. Phone/Fax

Practice location:
  • Phone: 620-874-2499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1282
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: