Healthcare Provider Details

I. General information

NPI: 1295879336
Provider Name (Legal Business Name): STEPHANIE M SIMMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 200D
SAINT LOUIS MO
63131-2328
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7272
  • Fax: 314-996-6785
Mailing address:
  • Phone: 314-996-6785
  • Fax: 314-996-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017024426
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2010011532
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: