MEDICARE: STEPHEN RYAN SIMS RN

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	163WP0200X	Pediatric Registered Nurse	821869	TX

General Provider Information

NPI Number	:	1538033238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN RYAN SIMS RN

Provider Business Mailing Address
First Line	:	7910 WINTERFELL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 WINTERFELL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4367
Country	:	US
Telephone Number	:	409-377-0109
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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