Healthcare Provider Details

I. General information

NPI: 1134540560
Provider Name (Legal Business Name): TOMMY KENT SIMS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E LAVIELLE ST
KIRBYVILLE TX
75956-2119
US

IV. Provider business mailing address

205 E LAVIELLE ST
KIRBYVILLE TX
75956-2119
US

V. Phone/Fax

Practice location:
  • Phone: 404-232-2117
  • Fax: 409-423-2421
Mailing address:
  • Phone: 404-232-2117
  • Fax: 409-423-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: