Provider Demographics
NPI:1376936815
Name:SIMM, KELSEY ANNE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANNE
Last Name:SIMM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:ANNE
Other - Last Name:QUEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:12 ROBBINS LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2001
Mailing Address - Country:US
Mailing Address - Phone:774-254-1794
Mailing Address - Fax:
Practice Address - Street 1:483B GREAT NECK RD S
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3707
Practice Address - Country:US
Practice Address - Phone:508-477-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily