=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588658728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA LYNN SIMMONS-RIOS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2005
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 HUDSPETH ST STE B
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76950-8004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-387-7911
-----------------------------------------------------
Fax | 325-387-7912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ROUTE 1 BOX 52A
-----------------------------------------------------
City | ELDORADO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76936-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-853-3137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 525494
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 525494
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------