Individual
DEREK SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7551
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7551
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201707902NP-PP
OR
363LF0000X
Family Nurse Practitioner
AP60790052
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2094955
—
WA
Enumeration date
05/28/2015
Last updated
09/06/2023
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