Provider Demographics
NPI:1497108005
Name:SIMS, KRISTEN (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 COBBLESTONE WAY CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5402
Mailing Address - Country:US
Mailing Address - Phone:210-260-5216
Mailing Address - Fax:
Practice Address - Street 1:2129 COBBLESTONE WAY CT
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5402
Practice Address - Country:US
Practice Address - Phone:210-260-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000252162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer