=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477476968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADDISON ERYKAH BRI-AN SIMMONS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2026
-----------------------------------------------------
Last Update Date | 08/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 15TH ST
-----------------------------------------------------
City | WEST SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95691-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-454-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2066 WYNDHAM WAY
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95242-4807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-684-8327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95040727
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------