Provider Demographics
NPI:1093834715
Name:SIMMONS, KENT EUGENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:EUGENE
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 MANLEY CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3430
Mailing Address - Country:US
Mailing Address - Phone:661-872-1903
Mailing Address - Fax:
Practice Address - Street 1:9500 STOCKDALE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3620
Practice Address - Country:US
Practice Address - Phone:661-326-7536
Practice Address - Fax:661-321-0690
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7720 RN380780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily