Provider Demographics
NPI:1679582191
Name:SIMMONS, CARLA GAIL (PA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:GAIL
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:GAIL
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4611
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-759-7027
Practice Address - Street 1:2900 N I 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5155
Practice Address - Country:US
Practice Address - Phone:940-380-8155
Practice Address - Fax:940-380-8159
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193112301Medicaid
TX193112302Medicaid
TX193112304Medicaid
TX8J9524Medicare PIN
TX193112301Medicaid
TX8J9522Medicare PIN
TX8K7541Medicare UPIN
TXQ57219Medicare UPIN
TXTXB123427Medicare PIN