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General NPI Number Information
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NPI Number | 1619305828
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Entity Type | Individual
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Provider Name | SAMUEL SIMMONS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 1280 E CALVADA BLVD
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City | PAHRUMP
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State | NV
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Zip | 89048-5693
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Country | US
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Telephone | 775-751-3377
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Fax | 775-751-2323
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Provider Business Mailing Address
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Address Line | PO BOX 98978
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City | LAS VEGAS
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State | NV
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Zip | 89193-8978
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Country | US
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Telephone | 702-216-3346
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Fax | 702-671-6883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1690
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 200272
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1085
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License Number State | ID
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