Provider Demographics
NPI:1053072256
Name:SIMMONS, KIMBERLY (QBHP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-1134
Mailing Address - Country:US
Mailing Address - Phone:870-625-0273
Mailing Address - Fax:870-625-0275
Practice Address - Street 1:1355 TATE AVE
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-8064
Practice Address - Country:US
Practice Address - Phone:870-625-0273
Practice Address - Fax:870-625-0275
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator