Provider Demographics
NPI:1619287992
Name:SIMMONS, KAMECA MONIQUE (BA)
Entity Type:Individual
Prefix:
First Name:KAMECA
Middle Name:MONIQUE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 HEADRICK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-2502
Mailing Address - Country:US
Mailing Address - Phone:702-277-1598
Mailing Address - Fax:
Practice Address - Street 1:4443 SUN VISTA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5450
Practice Address - Country:US
Practice Address - Phone:702-339-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health