Provider Demographics
NPI:1558734681
Name:SIMMONS, KATELYN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:SIMMONS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:7910 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4210
Practice Address - Country:US
Practice Address - Phone:513-232-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2024-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA2952363A00000X
IN10003578A363A00000X
OH50.006384RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant