Provider Demographics
NPI:1386846467
Name:SIMMONS, KELLIE (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:SIMMONS
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Gender:F
Credentials:CRNP
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:3/208N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-4739
Mailing Address - Fax:215-707-3677
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:GASTROENTEROLOGY - 3RD FL AMBULATORY CARE CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-9900
Practice Address - Fax:215-707-3831
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP008870364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health