Provider Demographics
NPI:1598439291
Name:SIMMONS, NIKKI LEE (MC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MILITARY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4945
Mailing Address - Country:US
Mailing Address - Phone:620-789-1428
Mailing Address - Fax:620-371-6465
Practice Address - Street 1:100 MILITARY AVE STE 205
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4945
Practice Address - Country:US
Practice Address - Phone:620-789-1428
Practice Address - Fax:620-371-6465
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03882-T103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling