=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679582191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA GAIL SIMMONS PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 N I 35
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-5155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-380-8155
-----------------------------------------------------
Fax | 940-380-8159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 W MAGNOLIA AVE
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-759-7000
-----------------------------------------------------
Fax | 817-759-7027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA04552
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------