Provider Demographics
NPI:1346607884
Name:SIMONDS, KADIE BURPEE (NP)
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:BURPEE
Last Name:SIMONDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KADIE
Other - Middle Name:BURPEE
Other - Last Name:SIMONDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4237 RICKENBACKER WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3710
Mailing Address - Country:US
Mailing Address - Phone:706-244-4789
Mailing Address - Fax:
Practice Address - Street 1:4237 RICKENBACKER WAY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3710
Practice Address - Country:US
Practice Address - Phone:706-244-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily