Provider Demographics
NPI:1316030448
Name:SAMMONS, DENISE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-9582
Mailing Address - Country:US
Mailing Address - Phone:308-224-0131
Mailing Address - Fax:
Practice Address - Street 1:4111 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2883
Practice Address - Country:US
Practice Address - Phone:308-237-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17984207Q00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06354OtherBCBS OF NE
NE4366OtherMIDLANDS CHOICE
NE06354OtherBCBS OF NE
NE4366OtherMIDLANDS CHOICE