Provider Demographics
NPI:1588227177
Name:SIMMONS, KATHRYN AMANDA (MSN, RN, ACCNS-AG)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:AMANDA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSN, RN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 DONAGHE ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2223
Mailing Address - Country:US
Mailing Address - Phone:540-290-8036
Mailing Address - Fax:
Practice Address - Street 1:912 DONAGHE ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2223
Practice Address - Country:US
Practice Address - Phone:540-290-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015001058364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine