Healthcare Provider Details

I. General information

NPI: 1568090280
Provider Name (Legal Business Name): TYLER KENDRICK SIMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MAIN ST STE 402
HOUMA LA
70360-3403
US

IV. Provider business mailing address

8120 MAIN ST STE 402
HOUMA LA
70360-3403
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-3484
  • Fax: 985-873-3485
Mailing address:
  • Phone: 985-873-3484
  • Fax: 985-873-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number343450
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: