Healthcare Provider Details

I. General information

NPI: 1952149627
Provider Name (Legal Business Name): THOMAS ALAN MUMPUNI-SIMES FNP-C, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS ALAN SIMES FNP-C, RN

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 FOREMOST DR APT 8101
AUSTIN TX
78745-7385
US

IV. Provider business mailing address

1919 OAKWELL FARMS PKWY STE 105
SAN ANTONIO TX
78218-1779
US

V. Phone/Fax

Practice location:
  • Phone: 707-761-0659
  • Fax:
Mailing address:
  • Phone: 480-712-8319
  • Fax: 480-712-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1072267
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: