Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1059749 | TX |
N | 363LA2100X | Nurse Practitioner - Acute Care | 1059749 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1059749 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1059749 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1059749 | TX |
NPI | 1396403176 |
---|---|
Provider Name | Mrs. Beverly Marjorie Simmons |
First Address | Fort Worth, TX 76134-3426 |
Second Address | Plano, TX 75075-7738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2021 |
Last Update Date | 29/11/2021 |