Provider Demographics
NPI:1417378118
Name:SIMMONS, KATHLEEN BERNADETTE (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BERNADETTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 L ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3509
Mailing Address - Country:US
Mailing Address - Phone:202-770-5774
Mailing Address - Fax:
Practice Address - Street 1:1400 L ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3509
Practice Address - Country:US
Practice Address - Phone:202-770-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse