Healthcare Provider Details

I. General information

NPI: 1396403176
Provider Name (Legal Business Name): BEVERLY MARJORIE SIMMONS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W 15TH ST
PLANO TX
75075-7738
US

IV. Provider business mailing address

4 CHERRYRIDGE DR
FORT WORTH TX
76134-3426
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-6800
  • Fax:
Mailing address:
  • Phone: 682-203-1229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1059749
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1059749
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1059749
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1059749
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1059749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: