Provider Demographics
NPI:1043974678
Name:SIMS, KENZIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
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 1:57 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4284
Mailing Address - Country:US
Mailing Address - Phone:318-232-6071
Mailing Address - Fax:601-442-1908
Practice Address - Street 1:57 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4284
Practice Address - Country:US
Practice Address - Phone:318-232-6071
Practice Address - Fax:318-232-6072
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty