MEDICARE: MRS. AUTUM FABRE SIMMONS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024175436	VA

General Provider Information

NPI Number	:	1124537048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUTUM FABRE SIMMONS FNP-C

Provider Business Mailing Address
First Line	:	3100 SCHOFIELD RD
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7577
Country	:	US
Telephone Number	:	757-606-4573
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SCHOFIELD RD
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7577
Country	:	US
Telephone Number	:	757-606-4573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	07/27/2023

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