Healthcare Provider Details

I. General information

NPI: 1558715003
Provider Name (Legal Business Name): JESSIE MAE SIMMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVENUE SE SUITE 5600 OBGYN HOSPITALIST
ALBUQUERQUE NM
87106-4920
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-0922
  • Fax: 505-563-6380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2020-0647
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: