Provider Demographics
NPI:1164822813
Name:SIMMONS, JOHN (FNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9192 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8208
Mailing Address - Country:US
Mailing Address - Phone:602-374-4101
Mailing Address - Fax:602-441-0522
Practice Address - Street 1:520 NM HIGHWAY 564
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4873
Practice Address - Country:US
Practice Address - Phone:505-542-0090
Practice Address - Fax:520-542-0155
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126129363LF0000X
NMCNP-02772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily