Healthcare Provider Details

I. General information

NPI: 1164822813
Provider Name (Legal Business Name): JOHN SIMMONS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2014
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NM HIGHWAY 564
GALLUP NM
87301-4873
US

IV. Provider business mailing address

9192 W UNION HILLS DR
PEORIA AZ
85382-8208
US

V. Phone/Fax

Practice location:
  • Phone: 505-542-0090
  • Fax: 520-542-0155
Mailing address:
  • Phone: 602-374-4101
  • Fax: 602-441-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126129
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02772
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: