Healthcare Provider Details

I. General information

NPI: 1679492912
Provider Name (Legal Business Name): MICHEAL S SIMMONS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 SW WANAMAKER DR
TOPEKA KS
66614-5328
US

IV. Provider business mailing address

2921 SW WANAMAKER DR
TOPEKA KS
66614-5328
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-6860
  • Fax:
Mailing address:
  • Phone: 785-272-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: