Provider Demographics
NPI:1447770359
Name:SIMMS, KATHRYN DOLORES (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DOLORES
Last Name:SIMMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20055 LAKE CHABOT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5332
Mailing Address - Country:US
Mailing Address - Phone:415-885-3882
Mailing Address - Fax:
Practice Address - Street 1:20055 LAKE CHABOT RD STE 130
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5332
Practice Address - Country:US
Practice Address - Phone:415-885-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016506363L00000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner