Provider Demographics
NPI:1184860595
Name:SIMKINS, KELLY C (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:SIMKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD STE 341C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2354
Mailing Address - Country:US
Mailing Address - Phone:615-826-1716
Mailing Address - Fax:615-826-4841
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD STE 341C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2354
Practice Address - Country:US
Practice Address - Phone:615-826-1716
Practice Address - Fax:615-826-4841
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122362207V00000X
TN3811207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122362Medicaid