Provider Demographics
NPI:1285814954
Name:SIMMONS, BRENDA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MICHELLE
Last Name:SIMMONS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 JEMEZ PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0562
Mailing Address - Country:US
Mailing Address - Phone:615-473-6135
Mailing Address - Fax:
Practice Address - Street 1:3320 N BUFFALO DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7410
Practice Address - Country:US
Practice Address - Phone:028-696-1907
Practice Address - Fax:702-869-6199
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12987363L00000X
NV824031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily