Provider Demographics
NPI:1275511321
Name:SIMMONS, VICKEY L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:VICKEY
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S SANTA FE AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4190
Mailing Address - Country:US
Mailing Address - Phone:785-827-2238
Mailing Address - Fax:785-827-1684
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-827-2238
Practice Address - Fax:785-827-1684
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200002330DMedicaid
KS145962OtherBCBS KS
KS20002330BMedicaid
KSP87996Medicare UPIN
KS20002330BMedicaid
KS145962Medicare PIN