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General NPI Number Information
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NPI Number | 1982564795
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Entity Type | Individual
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Provider Name | JEREMIAH SIMMONS
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2698 N GALLOWAY AVE STE 101
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City | MESQUITE
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State | TX
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Zip | 75150-6384
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Country | US
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Telephone | 972-288-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 PASEO FELIZ DR
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City | EL PASO
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State | TX
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Zip | 79928-5663
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Country | US
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Telephone |
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 56331
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License Number State | TX
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